MEDICARE: MR. KHALFANI MWAMBA CDP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP00005174	WA

General Provider Information

NPI Number	:	1295949766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KHALFANI MWAMBA CDP

Provider Business Mailing Address
First Line	:	1600 E. OLIVE ST.
Second Line	:	SOUND MENTAL HEALTH
City	:	SEATTLE
State	:	WA
Zip	:	98118-4425
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	206-302-2210

Provider Business Practice Location Address
First Line	:	400 YESLER WAY
Second Line	:	#110
City	:	SEATTLE
State	:	WA
Zip	:	98104-2683
Country	:	US
Telephone Number	:	206-302-2200
Fax Number	:	306-302-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	03/26/2013

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