Provider Demographics
NPI:1124245907
Name:WELLER, KATHERINE LENA (MFT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LENA
Last Name:WELLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 SPRING STREET
Mailing Address - Street 2:PMB 125
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250
Mailing Address - Country:US
Mailing Address - Phone:360-378-2032
Mailing Address - Fax:
Practice Address - Street 1:710 NASH ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7604
Practice Address - Country:US
Practice Address - Phone:360-968-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002257106H00000X
CA27594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27594OtherBBSE CA
WALF00002257OtherWA DEPT. OF HEALTH LICENSING