Healthcare Provider Details

I. General information

NPI: 1033558226
Provider Name (Legal Business Name): ADRIANA S PRENGLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 114TH AVE SE STE 105
BELLEVUE WA
98004-6934
US

IV. Provider business mailing address

1450 114TH AVE SE STE 105
BELLEVUE WA
98004-6934
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-0886
  • Fax:
Mailing address:
  • Phone: 425-455-0886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA S PRENGLER
Title or Position: OWNER
Credential: LMHC
Phone: 425-455-0886