Provider Demographics
NPI:1750656062
Name:BALL, MARY BETH (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14235 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1517
Mailing Address - Country:US
Mailing Address - Phone:206-310-0993
Mailing Address - Fax:206-325-6516
Practice Address - Street 1:502 RAINIER AVE. S.
Practice Address - Street 2:STE #204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144
Practice Address - Country:US
Practice Address - Phone:206-678-7064
Practice Address - Fax:206-325-6516
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist