Healthcare Provider Details

I. General information

NPI: 1033708557
Provider Name (Legal Business Name): GREGORY LUKE RAZZANO MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 24TH AVE S STE 260
SEATTLE WA
98144-4644
US

IV. Provider business mailing address

2100 24TH AVE S STE 260
SEATTLE WA
98144-4644
US

V. Phone/Fax

Practice location:
  • Phone: 206-382-5340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number002119
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61491880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: