Provider Demographics
NPI:1609322239
Name:DEFOREST, KATLYN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:DEFOREST
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:
Other - Last Name:TRUESDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4710 48TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1830
Mailing Address - Country:US
Mailing Address - Phone:602-793-7977
Mailing Address - Fax:
Practice Address - Street 1:4710 48TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1830
Practice Address - Country:US
Practice Address - Phone:602-793-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health