Provider Demographics
NPI:1912542689
Name:AYRISS, LINDA ANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:AYRISS
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:PO BOX 2913
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-2913
Mailing Address - Country:US
Mailing Address - Phone:206-714-0450
Mailing Address - Fax:
Practice Address - Street 1:334 ERICKSEN AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1854
Practice Address - Country:US
Practice Address - Phone:206-714-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60914004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist