Healthcare Provider Details

I. General information

NPI: 1225540784
Provider Name (Legal Business Name): BRANDY L OTO LMHC, CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27203 216TH AVE SE STE 6
MAPLE VALLEY WA
98038-3273
US

IV. Provider business mailing address

27203 216TH AVE SE STE 5
MAPLE VALLEY WA
98038-3273
US

V. Phone/Fax

Practice location:
  • Phone: 425-243-2094
  • Fax:
Mailing address:
  • Phone: 253-334-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60771178
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP0005749
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: