Healthcare Provider Details

I. General information

NPI: 1194653766
Provider Name (Legal Business Name): OMOIYARI PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 S GRAND BLVD STE 8714
SPOKANE WA
99203-9998
US

IV. Provider business mailing address

3120 S GRAND BLVD STE 8714
SPOKANE WA
99203-9998
US

V. Phone/Fax

Practice location:
  • Phone: 509-991-4176
  • Fax:
Mailing address:
  • Phone: 509-991-4176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LEE ANNE FISHER
Title or Position: OWNER/CLINICIAN
Credential: LICSW
Phone: 509-991-4176