Provider Demographics
NPI:1982722997
Name:PEDERSEN, BECKY MARIE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:MARIE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:BECKY
Other - Middle Name:MARIE
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:1110 GOLF CLUB RD SE STE 101
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 GOLF CLUB RD SE STE 101
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2302
Practice Address - Country:US
Practice Address - Phone:360-402-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200649402OtherFEDERAL TAX ID