Provider Demographics
NPI:1932836186
Name:BEARE, MARYSSA
Entity Type:Individual
Prefix:
First Name:MARYSSA
Middle Name:
Last Name:BEARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21905 MOUNTAIN HWY E UNIT 5078
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8550
Mailing Address - Country:US
Mailing Address - Phone:253-583-6599
Mailing Address - Fax:
Practice Address - Street 1:21510 66TH AVE E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-5802
Practice Address - Country:US
Practice Address - Phone:253-583-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist