Provider Demographics
NPI:1265563183
Name:SMITH, KATHRYN LEA (MC, LMHC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S WASHINGTON ST
Mailing Address - Street 2:#205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3412
Mailing Address - Country:US
Mailing Address - Phone:206-623-9181
Mailing Address - Fax:
Practice Address - Street 1:85 S WASHINGTON ST
Practice Address - Street 2:#205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3412
Practice Address - Country:US
Practice Address - Phone:206-623-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health