Healthcare Provider Details

I. General information

NPI: 1598634636
Provider Name (Legal Business Name): MARIA KOTCHETOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 3RD
MEDICAL LAKE WA
99022-0016
US

IV. Provider business mailing address

19145 NE 66TH WAY
REDMOND WA
98052-0565
US

V. Phone/Fax

Practice location:
  • Phone: 509-565-3100
  • Fax:
Mailing address:
  • Phone: 425-444-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: