Healthcare Provider Details

I. General information

NPI: 1689422081
Provider Name (Legal Business Name): MARK PONCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 6TH AVE STE 826
SEATTLE WA
98121-2593
US

IV. Provider business mailing address

14249 SE 6TH ST APT K101
BELLEVUE WA
98007-7040
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-8918
  • Fax:
Mailing address:
  • Phone: 206-331-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: