Provider Demographics
NPI:1518388230
Name:MUNGER, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MUNGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8975
Mailing Address - Country:US
Mailing Address - Phone:425-295-7697
Mailing Address - Fax:
Practice Address - Street 1:1495 NW GILMAN BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8975
Practice Address - Country:US
Practice Address - Phone:425-295-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60312903101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor