Healthcare Provider Details

I. General information

NPI: 1144720475
Provider Name (Legal Business Name): DEBORAH PAXTON KUKAHIKO LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 GROVE ST
MARYSVILLE WA
98270-4328
US

IV. Provider business mailing address

PO BOX 1498
MARYSVILLE WA
98270-1498
US

V. Phone/Fax

Practice location:
  • Phone: 425-320-6381
  • Fax:
Mailing address:
  • Phone: 425-320-6381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60691336
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: