Healthcare Provider Details

I. General information

NPI: 1609343904
Provider Name (Legal Business Name): NGOCRINE NHAN AYVAZOV LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NGOC 'VERONICA' AYVAZOV LMFT

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19220 37TH AVE NE
LAKE FOREST PARK WA
98155-2722
US

IV. Provider business mailing address

19220 37TH AVE NE
LAKE FOREST PARK WA
98155-2722
US

V. Phone/Fax

Practice location:
  • Phone: 206-580-3335
  • Fax:
Mailing address:
  • Phone: 206-580-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1609343904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: