Healthcare Provider Details

I. General information

NPI: 1144501115
Provider Name (Legal Business Name): ALLEGRA HOLLENBECK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19803 108TH AVE NE
BOTHELL WA
98011-2414
US

IV. Provider business mailing address

19803 108TH AVE NE
BOTHELL WA
98011-2414
US

V. Phone/Fax

Practice location:
  • Phone: 818-605-7719
  • Fax:
Mailing address:
  • Phone: 818-605-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT86911
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: