Provider Demographics
NPI:1164850426
Name:GRADY, DEBRA (MA - PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:MA - PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 5TH AVE S
Mailing Address - Street 2:STE 204
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3481
Mailing Address - Country:US
Mailing Address - Phone:425-478-6787
Mailing Address - Fax:425-585-0657
Practice Address - Street 1:201 5TH AVE S
Practice Address - Street 2:STE 204
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3481
Practice Address - Country:US
Practice Address - Phone:425-478-6787
Practice Address - Fax:425-585-0657
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60332004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health