Provider Demographics
NPI:1376836684
Name:MEREDITH, REBECCA W (MA LMHC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:W
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E EDGAR ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3132
Mailing Address - Country:US
Mailing Address - Phone:206-979-7456
Mailing Address - Fax:206-568-3224
Practice Address - Street 1:124 E EDGAR ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3132
Practice Address - Country:US
Practice Address - Phone:206-979-7456
Practice Address - Fax:206-568-3224
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011131101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor