Provider Demographics
NPI:1154037240
Name:PACE, MYKE (LMHCA)
Entity type:Individual
Prefix:
First Name:MYKE
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 NE 96TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-5338
Mailing Address - Country:US
Mailing Address - Phone:360-991-1739
Mailing Address - Fax:
Practice Address - Street 1:3501 NE 96TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-5338
Practice Address - Country:US
Practice Address - Phone:360-991-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61332256101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor