Healthcare Provider Details

I. General information

NPI: 1962552034
Provider Name (Legal Business Name): AFSOON EFTEKHARI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 MERIDIAN AVE N SUITE 110
SEATTLE WA
98133-9010
US

IV. Provider business mailing address

10740 MERIDIAN AVE N SUITE 110
SEATTLE WA
98133-9010
US

V. Phone/Fax

Practice location:
  • Phone: 206-931-5686
  • Fax: 206-417-8304
Mailing address:
  • Phone: 206-931-5686
  • Fax: 206-417-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002918
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: