Provider Demographics
NPI:1871250928
Name:HYATT, KACY MAREE
Entity Type:Individual
Prefix:
First Name:KACY
Middle Name:MAREE
Last Name:HYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 4TH AVE W APT 309
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4408
Mailing Address - Country:US
Mailing Address - Phone:703-209-5390
Mailing Address - Fax:
Practice Address - Street 1:6112 GOULD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2959
Practice Address - Country:US
Practice Address - Phone:202-780-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst