Healthcare Provider Details

I. General information

NPI: 1194290957
Provider Name (Legal Business Name): MAYRA MUIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW HOLDEN ST
SEATTLE WA
98126
UM

IV. Provider business mailing address

1701 18TH AVE S
SEATTLE WA
98144-4317
US

V. Phone/Fax

Practice location:
  • Phone: 206-933-7199
  • Fax:
Mailing address:
  • Phone: 206-731-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP70020642
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: