Healthcare Provider Details

I. General information

NPI: 1194820092
Provider Name (Legal Business Name): LEYLA RUTH BROWN WELKIN HAKSAR PHD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 THACKERAY PL NE
SEATTLE WA
98105-4842
US

IV. Provider business mailing address

14906 SUNRISE DR NE
BAINBRIDGE ISLAND WA
98110-1113
US

V. Phone/Fax

Practice location:
  • Phone: 206-954-4629
  • Fax:
Mailing address:
  • Phone: 206-954-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00003439
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLH00003439
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: