Healthcare Provider Details

I. General information

NPI: 1265901169
Provider Name (Legal Business Name): MORIAH BENTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 45TH ST STE 600
SEATTLE WA
98105-4696
US

IV. Provider business mailing address

3407 92ND ST S APT 2
LAKEWOOD WA
98499-9268
US

V. Phone/Fax

Practice location:
  • Phone: 206-607-9398
  • Fax:
Mailing address:
  • Phone: 253-221-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61009098
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: