Basic Information
| Provider Information | |||||||||
| NPI: | 1083212922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MECKLE | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 PACIFIC AVE STE C3 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984087423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533638853 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19350 GRAND MOUND WAY SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985799218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538885827 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2020 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CG60823258 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | CL60868479 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.