Healthcare Provider Details

I. General information

NPI: 1831603851
Provider Name (Legal Business Name): MINZA CHEYO KUYENGA NA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINZA ISAACK CHEYO NA

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14020 176TH ST E
PUYALLUP WA
98374-9294
US

IV. Provider business mailing address

14020 176TH ST E
PUYALLUP WA
98374-9294
US

V. Phone/Fax

Practice location:
  • Phone: 206-816-5175
  • Fax:
Mailing address:
  • Phone: 206-816-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: