Healthcare Provider Details

I. General information

NPI: 1275446817
Provider Name (Legal Business Name): KOMAL AMBATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31405 18TH AVE S
FEDERAL WAY WA
98003-5433
US

IV. Provider business mailing address

3112 MILTON DR
MELISSA TX
75454-9849
US

V. Phone/Fax

Practice location:
  • Phone: 253-681-6640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70166224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: