Healthcare Provider Details

I. General information

NPI: 1558128488
Provider Name (Legal Business Name): OLUSOLA AMOPE-AMOSUN LEON LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 SW 320TH ST
FEDERAL WAY WA
98023-2292
US

IV. Provider business mailing address

2461 62ND AVE E
FEDERAL WAY WA
98023-2292
US

V. Phone/Fax

Practice location:
  • Phone: 425-728-0025
  • Fax:
Mailing address:
  • Phone: 425-728-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61528354
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: