Healthcare Provider Details

I. General information

NPI: 1154112183
Provider Name (Legal Business Name): MOLLY ROKLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2025
Last Update Date: 05/17/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 EDGEWATER LN NE
LAKE FOREST PARK WA
98155-7729
US

IV. Provider business mailing address

1674 CAPISTRANO AVE
BERKELEY CA
94707-1804
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-8559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61670358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: