Healthcare Provider Details

I. General information

NPI: 1770291494
Provider Name (Legal Business Name): LUIS ROSALES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 164TH AVE NE
BELLEVUE WA
98008-3518
US

IV. Provider business mailing address

999 164TH AVE NE
BELLEVUE WA
98008-3518
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-4937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: