Healthcare Provider Details

I. General information

NPI: 1316348071
Provider Name (Legal Business Name): ANDREW J OHLSTROM MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ALASKAN WAY S STE 200
SEATTLE WA
98104-2785
US

IV. Provider business mailing address

16819 53RD AVE S
TUKWILA WA
98188-3249
US

V. Phone/Fax

Practice location:
  • Phone: 206-761-5929
  • Fax:
Mailing address:
  • Phone: 206-354-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61237432
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: