Provider Demographics
NPI:1558639450
Name:CONCINNITY, NICOLE D (MA, LMFT, CMHS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:CONCINNITY
Suffix:
Gender:F
Credentials:MA, LMFT, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTH 36TH STREET, SUITE 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8697
Mailing Address - Country:US
Mailing Address - Phone:206-310-4535
Mailing Address - Fax:
Practice Address - Street 1:600 NORTH 36TH STREET, SUITE 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8697
Practice Address - Country:US
Practice Address - Phone:206-310-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60209001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist