Healthcare Provider Details

I. General information

NPI: 1578359824
Provider Name (Legal Business Name): NATASHA OMURA-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA OMURA

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 112TH ST E STE 215
PUYALLUP WA
98373-3206
US

IV. Provider business mailing address

8720 172ND ST E
PUYALLUP WA
98375-2272
US

V. Phone/Fax

Practice location:
  • Phone: 253-446-7176
  • Fax:
Mailing address:
  • Phone: 253-298-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61644026
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: