=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245088384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CICILY JUSTINA NECE MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2024
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18606 48TH PL S
-----------------------------------------------------
City | SEATAC
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-8608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-617-7611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 W RIVERSIDE AVE STE N
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-0581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-617-7611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | MC61627306
-----------------------------------------------------
License Number State |
-----------------------------------------------------