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General NPI Number Information
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NPI Number | 1508578360
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Entity Type | Individual
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Provider Name | BANUJAH KOELMEYER LMHCA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 195 NE GILMAN BLVD STE 100
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City | ISSAQUAH
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State | WA
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Zip | 98027-2940
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Country | US
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Telephone | 425-295-7697
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Fax |
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Provider Business Mailing Address
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Address Line | 7812 RIVERVIEW RD
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City | SNOHOMISH
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State | WA
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Zip | 98290-5885
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Country | US
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Telephone |
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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 | MC61387901
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License Number State | WA
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