Healthcare Provider Details

I. General information

NPI: 1235423781
Provider Name (Legal Business Name): HARUKO WATANABE MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HARUKO CHOOSAKUL MA, LMHC

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 01/18/2024
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-257-6600
  • Fax: 206-257-6830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60206015
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: