Provider Demographics
NPI:1427567825
Name:BENNICK, AMBER (LMHCA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BENNICK
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 EVERGREEN WAY STE Z154
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3889
Mailing Address - Country:US
Mailing Address - Phone:425-263-3006
Mailing Address - Fax:
Practice Address - Street 1:9930 EVERGREEN WAY STE Z154
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3889
Practice Address - Country:US
Practice Address - Phone:425-263-3006
Practice Address - Fax:425-263-3007
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61468065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC61468065Medicaid