Provider Demographics
NPI:1275363897
Name:PACKARD, ALEXANDRIA (LMFTA)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:PACKARD
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14616 450TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9765
Mailing Address - Country:US
Mailing Address - Phone:206-518-2849
Mailing Address - Fax:
Practice Address - Street 1:301 W NORTH BEND WAY STE 109
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8163
Practice Address - Country:US
Practice Address - Phone:206-518-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61566060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist