Provider Demographics
NPI:1306292792
Name:PERNA, EMILY (MMT, LMHC, MT-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PERNA
Suffix:
Gender:F
Credentials:MMT, LMHC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23133 80TH PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8715
Mailing Address - Country:US
Mailing Address - Phone:267-320-0706
Mailing Address - Fax:
Practice Address - Street 1:7522 221ST PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8029
Practice Address - Country:US
Practice Address - Phone:425-521-6533
Practice Address - Fax:425-775-7210
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
WALH61473896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH61473896OtherLICENSED MENTAL HEALTH COUNSELOR