Healthcare Provider Details

I. General information

NPI: 1437140092
Provider Name (Legal Business Name): MARK WSEVOLOD ISAJIW L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 6180, BOX 245
APO AE
09604-0245
IT

IV. Provider business mailing address

PSC 53, BOX 1861
APO AE
09601
IT

V. Phone/Fax

Practice location:
  • Phone: 43-430-5321
  • Fax: 43-430-5668
Mailing address:
  • Phone: 43-430-5321
  • Fax: 04345668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00004144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: