Provider Demographics
NPI:1326772989
Name:WHITE, MAKAEL LEE (LMFTA)
Entity Type:Individual
Prefix:
First Name:MAKAEL
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 S PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4806
Mailing Address - Country:US
Mailing Address - Phone:206-348-9385
Mailing Address - Fax:
Practice Address - Street 1:1011 E MAIN STE 103
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6768
Practice Address - Country:US
Practice Address - Phone:253-290-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61328543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist