Individual provider Active NPI

Maytal Grossman, LMFT

  • Marriage & Family Therapist
  • Tukwila, WA
National Provider Identifier
1598022584
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
15455 65TH Ave S
Tukwila, WA 98188-2534
Phone
(206) 721-5170
NPI assigned
Apr 16, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X Primary

Addresses

Primary practice location

15455 65TH Ave S
Tukwila, WA 98188-2534

Mailing address

PO Box 2429
Longview, WA 98632-8486
Phone (360) 353-9431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240221000758 TX Practitioner - Marriage and Family Therapist 0941644678 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cowlitz Indian Tribe CurrentSince Jan 13, 2024 Accepting new patients
Cowlitz Indian Tribe CurrentSince Jan 13, 2024 Accepting new patients
Cowlitz Indian Tribe Past Accepting new patients

Locations

1000 Davis Pl
DuPont, WA 98327
Phone (206) 721-5170

15455 65th Ave S
Tukwila, WA 98188
Phone (206) 721-5170

6450 Southcenter Blvd
Tukwila, WA 98188
Phone (206) 446-5410

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1598022584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2429",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328486",
            "telephone_number": "360-353-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15455 65TH AVE S",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882534",
            "telephone_number": "206-721-5170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "MAYTAL",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-16",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tukwila, WA

Sources for this page

Verify at the official NPI Registry.