Healthcare Provider Details

I. General information

NPI: 1063990661
Provider Name (Legal Business Name): KYONG YIM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 17TH AVE NW STE 1746
SEATTLE WA
98107-5232
US

IV. Provider business mailing address

5608 17TH AVE NW STE 1746
SEATTLE WA
98107-5232
US

V. Phone/Fax

Practice location:
  • Phone: 425-202-5523
  • Fax:
Mailing address:
  • Phone: 425-202-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61062996
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: