Provider Demographics
NPI:1245388602
Name:BIRCH, MARIAN (DMH)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:BIRCH
Suffix:
Gender:F
Credentials:DMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:113 SOUTH EUNICE STREET
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0185
Mailing Address - Country:US
Mailing Address - Phone:360-417-3065
Mailing Address - Fax:360-417-3065
Practice Address - Street 1:113 S EUNICE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3333
Practice Address - Country:US
Practice Address - Phone:360-417-3065
Practice Address - Fax:360-417-3065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1906103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist