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General NPI Number Information
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NPI Number | 1346711744
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Entity Type | Individual
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Provider Name | AKIRA FAJAR
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Gender | Male
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 2600 SW HOLDEN ST
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City | SEATTLE
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State | WA
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Zip | 98126-3505
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Country | US
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Telephone | 206-933-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 432 SW 155TH ST APT A
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City | BURIEN
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State | WA
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Zip | 98166-4417
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Country | US
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Telephone | 701-541-5279
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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 |
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License Number State | WA
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