Provider Demographics
NPI:1285691766
Name:MYHRE, KATHLEEN MARIE (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MYHRE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MAPLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-3301
Mailing Address - Country:US
Mailing Address - Phone:360-563-0847
Mailing Address - Fax:360-563-0827
Practice Address - Street 1:312 MAPLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-3301
Practice Address - Country:US
Practice Address - Phone:360-563-0847
Practice Address - Fax:360-563-0827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical