Healthcare Provider Details

I. General information

NPI: 1083144471
Provider Name (Legal Business Name): MELANIE UKOSAKUL LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST STE 307
SEATTLE WA
98103-8889
US

IV. Provider business mailing address

4603 S HOLLY ST UNIT B
SEATTLE WA
98118-3329
US

V. Phone/Fax

Practice location:
  • Phone: 206-485-3244
  • Fax:
Mailing address:
  • Phone: 206-673-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60660689
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: