Provider Demographics
NPI:1346946167
Name:BERRY, GEORGIA LEE (MA, LMFTA, LMHCA)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MA, LMFTA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 CAROLINA ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5227
Mailing Address - Country:US
Mailing Address - Phone:360-790-3882
Mailing Address - Fax:
Practice Address - Street 1:6627 CAROLINA ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-5227
Practice Address - Country:US
Practice Address - Phone:360-790-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61228444106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist