Provider Demographics
NPI:1497822589
Name:MAYNARD, MARIAN LEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:LEE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NW 85TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4237
Mailing Address - Country:US
Mailing Address - Phone:206-789-1881
Mailing Address - Fax:206-789-0336
Practice Address - Street 1:1405 NW 85TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4237
Practice Address - Country:US
Practice Address - Phone:206-789-1881
Practice Address - Fax:206-789-0336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional