Provider Demographics
NPI:1619247921
Name:PLUMB, AMY MICHELLE (MA, LMHC, SUDP, CPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:PLUMB
Suffix:
Gender:F
Credentials:MA, LMHC, SUDP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N MERIDIAN STE 100-174
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4409
Mailing Address - Country:US
Mailing Address - Phone:206-429-1763
Mailing Address - Fax:206-299-0357
Practice Address - Street 1:1002 N MERIDIAN STE 100-174
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4409
Practice Address - Country:US
Practice Address - Phone:206-429-1763
Practice Address - Fax:206-299-0357
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60463078101YA0400X
WALH60403531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2049950Medicaid