Healthcare Provider Details

I. General information

NPI: 1316009632
Provider Name (Legal Business Name): MICHAEL YUKIO NAKAYAMA LICSW, GMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST MS: E-120
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

1550 N 115TH ST MS: E-120
SEATTLE WA
98133-8401
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-1172
  • Fax: 206-368-1489
Mailing address:
  • Phone: 206-368-1172
  • Fax: 206-368-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00047472
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLW00009568
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: