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General NPI Number Information
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NPI Number | 1598269110
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Entity Type | Organization
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Legal Business Name | SEATTLE THERAPY PRACTICE, PLLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 338 NW 85TH ST
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City | SEATTLE
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State | WA
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Zip | 98117-3120
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Country | US
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Telephone | 206-659-5945
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Fax | 206-494-4562
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Provider Business Mailing Address
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Address Line | 338 NW 85TH ST
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City | SEATTLE
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State | WA
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Zip | 98117-3120
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Country | US
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Telephone | 206-659-5945
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Fax | 206-494-4562
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | DR. AGNES KWONG
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Credential | PHD
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Telephone | 206-659-5945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY60126753
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW60686077
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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