Provider Demographics
NPI:1225281892
Name:FENN, MARILYN FREIDA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:FREIDA
Last Name:FENN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:FREIDA
Other - Last Name:FENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1520 JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368
Mailing Address - Country:US
Mailing Address - Phone:360-390-8337
Mailing Address - Fax:360-447-6030
Practice Address - Street 1:1520 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-8152
Practice Address - Country:US
Practice Address - Phone:360-390-8337
Practice Address - Fax:360-447-6030
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60256546101YM0800X
WALF60256546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12733314OtherCAQH
WALF 60256546OtherWASHINGTON STATE LMFT LICENSE NUMBER