Healthcare Provider Details

I. General information

NPI: 1972095008
Provider Name (Legal Business Name): YISHEN LI LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 15TH AVE SW
SEATTLE WA
98106-2576
US

IV. Provider business mailing address

64 ELDREDGE ST
NEWTON MA
02458-2017
US

V. Phone/Fax

Practice location:
  • Phone: 206-965-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW61400081
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: