Provider Demographics
NPI:1013547439
Name:UMPOROWICZ, CARRIE (MA, LMFTA)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:UMPOROWICZ
Suffix:
Gender:F
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 173RD ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8921
Mailing Address - Country:US
Mailing Address - Phone:206-353-7293
Mailing Address - Fax:
Practice Address - Street 1:15406 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9504
Practice Address - Country:US
Practice Address - Phone:254-200-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61016150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health