1194091512 NPI number — AMANDA DAHIR LY BCBA-D, LMHC, PH.D

Table of content: AMANDA DAHIR LY BCBA-D, LMHC, PH.D (NPI 1194091512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194091512 NPI number — AMANDA DAHIR LY BCBA-D, LMHC, PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LY
Provider First Name:
AMANDA
Provider Middle Name:
DAHIR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA-D, LMHC, PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAHIR
Provider Other First Name:
AMANDA
Provider Other Middle Name:
MAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194091512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2018 156TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98007-3825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-589-0111
Provider Business Mailing Address Fax Number:
206-926-1685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2018 156TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-3825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-589-0111
Provider Business Practice Location Address Fax Number:
206-946-1685
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-09-5346 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LH60331438 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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