Provider Demographics
NPI:1760188718
Name:BLAND, PHYLLIS KNIGHT (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:KNIGHT
Last Name:BLAND
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11708 MADERA DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1483
Mailing Address - Country:US
Mailing Address - Phone:206-518-0982
Mailing Address - Fax:
Practice Address - Street 1:11708 MADERA DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1483
Practice Address - Country:US
Practice Address - Phone:206-518-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61387897106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist