Provider Demographics
NPI:1679620272
Name:BLYWISE, BARBARA (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:BLYWISE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 333RD ST
Mailing Address - Street 2:SUITE 129
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6309
Mailing Address - Country:US
Mailing Address - Phone:253-929-1529
Mailing Address - Fax:253-874-4382
Practice Address - Street 1:402 S 333RD ST
Practice Address - Street 2:SUITE 129
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6309
Practice Address - Country:US
Practice Address - Phone:253-929-1529
Practice Address - Fax:253-874-4382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health