Healthcare Provider Details

I. General information

NPI: 1033659560
Provider Name (Legal Business Name): TRACEY MOFIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACEY OSBORN

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTLAKE AVE N STE 510
SEATTLE WA
98109-3543
US

IV. Provider business mailing address

1200 WESTLAKE AVE N STE 510
SEATTLE WA
98109-3543
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-0554
  • Fax:
Mailing address:
  • Phone: 206-823-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60612318
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60633268
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60585615
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: