Healthcare Provider Details

I. General information

NPI: 1750507927
Provider Name (Legal Business Name): RANDOLPH T OKUMURA M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

IV. Provider business mailing address

3722 N PROCTOR ST
TACOMA WA
98407-6133
US

V. Phone/Fax

Practice location:
  • Phone: 253-581-7020
  • Fax:
Mailing address:
  • Phone: 253-307-6881
  • Fax: 253-584-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005373
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: