Healthcare Provider Details

I. General information

NPI: 1326578261
Provider Name (Legal Business Name): JOSEPH HENRY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 FAIRVIEW AVE E STE 200
SEATTLE WA
98102-3051
US

IV. Provider business mailing address

PO BOX 22075
SEATTLE WA
98122-0075
US

V. Phone/Fax

Practice location:
  • Phone: 206-785-3980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: