Provider Demographics
NPI:1558727081
Name:ORMISTON, KARLIE RENAE
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:RENAE
Last Name:ORMISTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:RENAE
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7935 N 205TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:714-717-4770
Mailing Address - Fax:
Practice Address - Street 1:7935 N 205TH ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:206-717-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-46315106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician