Basic Information
| Provider Information | |||||||||
| NPI: | 1881872901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRACY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | WUNDER | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4807 196TH ST SW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257744269 | ||||||||
| FaxNumber: | 4257441216 | ||||||||
| Practice Location | |||||||||
| Address1: | 4807 196TH ST SW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257744269 | ||||||||
| FaxNumber: | 4257441216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00043765 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.