Provider Demographics
NPI:1669012365
Name:GRAMMER, GEORGIA FAYE (MA, MED, LMFT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:FAYE
Last Name:GRAMMER
Suffix:
Gender:F
Credentials:MA, MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 219TH PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8231
Mailing Address - Country:US
Mailing Address - Phone:206-313-8522
Mailing Address - Fax:
Practice Address - Street 1:210 219TH PL SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8231
Practice Address - Country:US
Practice Address - Phone:206-313-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60930468106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist