Provider Demographics
NPI:1992027494
Name:BLANCHARD, MARY ADRIAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ADRIAN
Last Name:BLANCHARD
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 1:917 PACIFIC AVE
Mailing Address - Street 2:SUITE 416
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4446
Mailing Address - Country:US
Mailing Address - Phone:253-347-1983
Mailing Address - Fax:253-249-7199
Practice Address - Street 1:917 PACIFIC AVE
Practice Address - Street 2:SUITE 416
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4446
Practice Address - Country:US
Practice Address - Phone:253-347-1983
Practice Address - Fax:253-249-7199
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60089689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012092Medicaid
WA8952267OtherL&I