Provider Demographics
NPI:1023782265
Name:BLIVEN-LEE, AMY LYNNE (LMHC-A)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNNE
Last Name:BLIVEN-LEE
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12604 473RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8786
Mailing Address - Country:US
Mailing Address - Phone:425-281-4938
Mailing Address - Fax:
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE STE CANDD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:425-409-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61018300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health