Provider Demographics
NPI:1619262508
Name:LITTLE BIRD CHILD & FAMILY THERAPY
Entity Type:Organization
Organization Name:LITTLE BIRD CHILD & FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANAWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT CMHS
Authorized Official - Phone:360-348-7183
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-0782
Mailing Address - Country:US
Mailing Address - Phone:360-348-7183
Mailing Address - Fax:
Practice Address - Street 1:23634 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE C
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9322
Practice Address - Country:US
Practice Address - Phone:360-348-7183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60171874106H00000X
WALF60172289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty