Provider Demographics
NPI:1902133648
Name:MAY, MARTHA DENISE (MC60179768)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:DENISE
Last Name:MAY
Suffix:
Gender:F
Credentials:MC60179768
Other - Prefix:
Other - First Name:LIFELINE
Other - Middle Name:CONNECTIONS
Other - Last Name:SOUND BEND, WASHINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MC60179768
Mailing Address - Street 1:2204 PACIFIC AVE N
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-3300
Mailing Address - Country:US
Mailing Address - Phone:360-642-3787
Mailing Address - Fax:
Practice Address - Street 1:2204 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3300
Practice Address - Country:US
Practice Address - Phone:360-642-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60179768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health