Provider Demographics
NPI:1982089835
Name:MCCORMICK, MEG BLADT (LMHCA)
Entity type:Individual
Prefix:
First Name:MEG
Middle Name:BLADT
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:MAE
Other - Last Name:BLADT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4219 SW JUNEAU ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1621
Mailing Address - Country:US
Mailing Address - Phone:206-207-5395
Mailing Address - Fax:
Practice Address - Street 1:4219 SW JUNEAU ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1621
Practice Address - Country:US
Practice Address - Phone:206-207-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMC60997009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor