Healthcare Provider Details

I. General information

NPI: 1477044451
Provider Name (Legal Business Name): ALLORA SIERRA TVEDT LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 24TH AVE S # 206
SEATTLE WA
98144-4637
US

IV. Provider business mailing address

1537 15TH AVE S # B
SEATTLE WA
98144-3415
US

V. Phone/Fax

Practice location:
  • Phone: 206-437-7772
  • Fax:
Mailing address:
  • Phone: 509-460-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60774417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: