Individual
UY TU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LICSWA
Contact information
Practice address
4526 FEDERAL AVE, EVERETT, WA 98203-2132
(425) 349-6200
Mailing address
4526 FEDERAL AVE, EVERETT, WA 98203-2132
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CG60294779
WA
104100000X
Social Worker
Primary
SC60309236
WA
Other
Enumeration date
11/09/2021
Last updated
07/20/2022
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