Provider Demographics
NPI:1700087764
Name:MCCORMICK, KATHRYN ANN (LMFT, LMP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LMFT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 E MADISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4267
Mailing Address - Country:US
Mailing Address - Phone:206-322-7177
Mailing Address - Fax:
Practice Address - Street 1:3136 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4267
Practice Address - Country:US
Practice Address - Phone:206-322-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002037106H00000X
WAMA00008259172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172M00000XOther Service ProvidersMechanotherapist