=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811674559
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA T LAI LMFTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2023
-----------------------------------------------------
Last Update Date | 07/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3417 EVANSTON AVE N STE 423
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98103-8970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-580-3176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2212 QUEEN ANNE AVE N # 416
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98109-2383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-580-3176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MG61451354
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------