Provider Demographics
NPI:1376145375
Name:KATZ, MARGOT LILLIAN (SUDP)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:LILLIAN
Last Name:KATZ
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:MARGOT
Other - Middle Name:LILLIAN
Other - Last Name:HAMETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1875 CLARET LOOP NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8380
Mailing Address - Country:US
Mailing Address - Phone:530-400-4059
Mailing Address - Fax:
Practice Address - Street 1:19917 7TH AVE NE STE 205
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6555
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61006602101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)