Provider Demographics
NPI:1518200724
Name:MARSH, KATHERINE MARY (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:MARSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5191 CORPORATE CENTER COURT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-236-0206
Mailing Address - Fax:360-236-9909
Practice Address - Street 1:5191 CORPORATE CENTER COURT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-236-0206
Practice Address - Fax:360-236-9909
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60342353103TC0700X
VA0810004705103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical