1700078367 NPI number — MRS. DARLENE JOAN STROOT MA/MFT

Table of content: MRS. DARLENE JOAN STROOT MA/MFT (NPI 1700078367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700078367 NPI number — MRS. DARLENE JOAN STROOT MA/MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROOT
Provider First Name:
DARLENE
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA/MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700078367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 SOUTHCENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUKWILA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-444-7830
Provider Business Mailing Address Fax Number:
206-444-7810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3078 EL CAJON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92104-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-521-1743
Provider Business Practice Location Address Fax Number:
619-521-1836
Provider Enumeration Date:
08/16/2007

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: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: RC60042724 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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