Basic Information
Provider Information
NPI: 1487037305
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DE SMET
FirstName: AYSHEA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5127
Address2:  
City: EVERETT
State: WA
PostalCode: 982065127
CountryCode: US
TelephoneNumber: 4253048431
FaxNumber:  
Practice Location
Address1: 904 7TH AVE FL 6
Address2:  
City: SEATTLE
State: WA
PostalCode: 981041132
CountryCode: US
TelephoneNumber: 4253395453
FaxNumber: 4252524441
Other Information
ProviderEnumerationDate: 07/09/2015
LastUpdateDate: 04/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMC60533626WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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