Healthcare Provider Details

I. General information

NPI: 1528346947
Provider Name (Legal Business Name): LARA OKOLOKO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10303 MERIDIAN AVE N SUITE 200
SEATTLE WA
98133-9483
US

IV. Provider business mailing address

10303 MERIDIAN AVE N SUITE 200
SEATTLE WA
98133-9483
US

V. Phone/Fax

Practice location:
  • Phone: 206-588-5202
  • Fax:
Mailing address:
  • Phone: 206-588-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60108119
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60313068
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: