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General NPI Number Information
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NPI Number | 1851417810
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Entity Type | Organization
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Legal Business Name | OPTIMALLIFE WELLNESS CENTER
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 2320 130TH AVE NE STE 240
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City | BELLEVUE
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State | WA
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Zip | 98005-1718
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Country | US
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Telephone | 425-646-2778
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Fax | 425-453-6377
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Provider Business Mailing Address
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Address Line | 2320 130TH AVE NE STE 240
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City | BELLEVUE
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State | WA
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Zip | 98005-1718
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Country | US
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Telephone | 425-598-7132
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Fax | 425-453-6377
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Authorized Official
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Title or Position | OWNER
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Name | MS. LARA K SYMONDS
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Credential | MA
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Telephone | 206-459-5987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00001767
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License Number State | WA
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