Provider Demographics
NPI:1326567611
Name:FRITZ, CARLY MARY (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:MARY
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:MARY
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9050 15TH AVE NW APT 2
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3494
Mailing Address - Country:US
Mailing Address - Phone:509-220-4298
Mailing Address - Fax:
Practice Address - Street 1:123 NW 36TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4959
Practice Address - Country:US
Practice Address - Phone:509-220-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61070749101YM0800X
WAMC60887635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health