Provider Demographics
NPI:1063133494
Name:IVERSEN, MARY CATHERINE (LMHCA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:IVERSEN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:IVERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA
Mailing Address - Street 1:300 LENORA ST PMB 6218
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2411
Mailing Address - Country:US
Mailing Address - Phone:206-929-1525
Mailing Address - Fax:
Practice Address - Street 1:1426 35TH ST STE 1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4799
Practice Address - Country:US
Practice Address - Phone:425-375-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61312171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health