Provider Demographics
NPI:1790255834
Name:POULSEN, DEBBIE L (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:L
Last Name:POULSEN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S GRADY WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3217
Mailing Address - Country:US
Mailing Address - Phone:425-271-8546
Mailing Address - Fax:425-228-2007
Practice Address - Street 1:15 S GRADY WAY STE 500
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3217
Practice Address - Country:US
Practice Address - Phone:425-271-8546
Practice Address - Fax:425-228-2007
Is Sole Proprietor?:No
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health