1831392208 NPI number — MS. WAISAN WENDY LEE MS, LMFTA

Table of content: MS. WAISAN WENDY LEE MS, LMFTA (NPI 1831392208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831392208 NPI number — MS. WAISAN WENDY LEE MS, LMFTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
WAISAN
Provider Middle Name:
WENDY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
WENDY
Provider Other Middle Name:
WAISAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831392208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 NW MAPLE STREET
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-427-2474
Provider Business Mailing Address Fax Number:
425-458-4675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 NW MAPLE STREET
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ISSAQUAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-427-2474
Provider Business Practice Location Address Fax Number:
425-458-4675
Provider Enumeration Date:
06/06/2007

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 , with the licence number:  RC00045794 , 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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