Provider Demographics
NPI:1023660214
Name:MAXELL-HARRISON, CARMELA ANITA (LMHC)
Entity type:Individual
Prefix:
First Name:CARMELA
Middle Name:ANITA
Last Name:MAXELL-HARRISON
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 1:15 SW EVERETT MALL WAY
Mailing Address - Street 2:STE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-2715
Mailing Address - Country:US
Mailing Address - Phone:888-562-5442
Mailing Address - Fax:844-861-1929
Practice Address - Street 1:2320 ROCKEFELLER AVE # A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2832
Practice Address - Country:US
Practice Address - Phone:360-551-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60960472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty