=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770769648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTONIA ROSZITA MEJORADO LMHC, SUDP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2008
-----------------------------------------------------
Last Update Date | 09/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9575 ETHAN WADE WAY SE
-----------------------------------------------------
City | SNOQUALMIE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98065-9577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-831-5425
-----------------------------------------------------
Fax | 425-831-5428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1470
-----------------------------------------------------
City | SNOQUALMIE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98065-1470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-227-0261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP00005924
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH60647519
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------