Healthcare Provider Details

I. General information

NPI: 1295408540
Provider Name (Legal Business Name): NINA MARIE PARSON LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 NE 187TH ST APT 2223
BOTHELL WA
98011-9340
US

IV. Provider business mailing address

12605 NE 187TH ST APT 2223
BOTHELL WA
98011-9340
US

V. Phone/Fax

Practice location:
  • Phone: 808-726-8709
  • Fax:
Mailing address:
  • Phone: 808-726-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number615999687
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21-156423
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: