Provider Demographics
NPI:1265515951
Name:EBERHARDY, PHYLLISS MARIE (MS LMFT CCDCI)
Entity type:Individual
Prefix:
First Name:PHYLLISS
Middle Name:MARIE
Last Name:EBERHARDY
Suffix:
Gender:F
Credentials:MS LMFT CCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11126 SE 256TH STREET
Mailing Address - Street 2:SUITE O 204
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-5636
Mailing Address - Country:US
Mailing Address - Phone:253-852-1586
Mailing Address - Fax:253-852-7751
Practice Address - Street 1:11126 SE 256TH STREET
Practice Address - Street 2:SUITE O 204
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-5636
Practice Address - Country:US
Practice Address - Phone:253-852-1586
Practice Address - Fax:253-852-7751
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WACB00006138101YA0400X
WALF00001439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist