Healthcare Provider Details

I. General information

NPI: 1851417810
Provider Name (Legal Business Name): OPTIMALLIFE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/13/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 130TH AVE NE STE 240
BELLEVUE WA
98005-1718
US

IV. Provider business mailing address

2320 130TH AVE NE STE 240
BELLEVUE WA
98005-1718
US

V. Phone/Fax

Practice location:
  • Phone: 425-646-2778
  • Fax: 425-453-6377
Mailing address:
  • Phone: 425-598-7132
  • Fax: 425-453-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00001767
License Number StateWA

VIII. Authorized Official

Name: MS. LARA K SYMONDS
Title or Position: OWNER
Credential: MA
Phone: 206-459-5987