Provider Demographics
NPI:1952859985
Name:ANDERSON, MARLAINA (LMHC)
Entity Type:Individual
Prefix:
First Name:MARLAINA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 NW LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8348
Mailing Address - Country:US
Mailing Address - Phone:206-619-5374
Mailing Address - Fax:
Practice Address - Street 1:18820 FRONT ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7351
Practice Address - Country:US
Practice Address - Phone:206-619-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60635010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health