Provider Demographics
NPI:1588399539
Name:MCGOURTY, WENDY (LMHCA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MCGOURTY
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42911 N ELK CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:ELK
Mailing Address - State:WA
Mailing Address - Zip Code:99009-9715
Mailing Address - Country:US
Mailing Address - Phone:406-546-7370
Mailing Address - Fax:
Practice Address - Street 1:42911 N ELK CAMDEN RD
Practice Address - Street 2:
Practice Address - City:ELK
Practice Address - State:WA
Practice Address - Zip Code:99009-9715
Practice Address - Country:US
Practice Address - Phone:406-546-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61178138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health