Provider Demographics
NPI:1710601539
Name:TICE, AUDREY MAE (MFTA)
Entity Type:Individual
Prefix:PROF
First Name:AUDREY
Middle Name:MAE
Last Name:TICE
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:MAE
Other - Last Name:COFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER'S DEGREE
Mailing Address - Street 1:2041 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2959
Mailing Address - Country:US
Mailing Address - Phone:206-786-8228
Mailing Address - Fax:
Practice Address - Street 1:2041 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2959
Practice Address - Country:US
Practice Address - Phone:206-786-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist