Provider Demographics
NPI:1154872281
Name:FAY, JULIA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 EASTLAKE AVE E STE 325
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2366 EASTLAKE AVE E, SEATTLE, WA 98102
Practice Address - Street 2:STE 325
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-9810
Practice Address - Country:US
Practice Address - Phone:206-419-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60704372133N00000X
WA61017558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist