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General NPI Number Information
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NPI Number | 1114490380
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Entity Type | Individual
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Provider Name | JUDYLINE PADILLA CORPUZ LMHCA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 110 MAIN ST STE 104
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City | EDMONDS
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State | WA
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Zip | 98020-3180
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Country | US
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Telephone | 425-361-7987
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Fax |
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Provider Business Mailing Address
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Address Line | 407 30TH AVE APT A
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City | SEATTLE
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State | WA
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Zip | 98122-6232
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Country | US
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Telephone | 808-383-0452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC60896916
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License Number State | WA
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