Healthcare Provider Details

I. General information

NPI: 1164755583
Provider Name (Legal Business Name): MICHAEL ROBERT ALLISON M.A., L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 NE 51ST ST
SEATTLE WA
98105-5713
US

IV. Provider business mailing address

2271 NE 51ST ST
SEATTLE WA
98105-5713
US

V. Phone/Fax

Practice location:
  • Phone: 206-522-8553
  • Fax: 206-522-7815
Mailing address:
  • Phone: 206-522-8553
  • Fax: 206-522-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60040902
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: