Provider Demographics
NPI:1053172080
Name:HARTZ, MAILINH
Entity type:Individual
Prefix:
First Name:MAILINH
Middle Name:
Last Name:HARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 SW 144TH PL
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1062
Mailing Address - Country:US
Mailing Address - Phone:425-728-0548
Mailing Address - Fax:
Practice Address - Street 1:1509 SW 144TH PL
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1062
Practice Address - Country:US
Practice Address - Phone:425-728-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFTA.MG.61513917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist