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NPI Code Detail

MEDICARE: AMANDA AYUMI IBARAKI STINE

MEDICARE: AMANDA AYUMI IBARAKI STINE
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
1106H00000XMarriage & Family TherapistIMF76440CA
2106H00000XMarriage & Family TherapistMG60882994WA

General Provider Information

NPI Number : 1932450798
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA AYUMI IBARAKI STINE
Provider Business Mailing Address
First Line : 4432 48TH AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4018
Country : US
Telephone Number : 650-207-8232
Fax Number :
Provider Business Practice Location Address
First Line : 4219 SW JUNEAU ST
Second Line :
City : SEATTLE
State : WA
Zip : 98136-1621
Country : US
Telephone Number : 206-207-5395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/25/2019

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Directions to “ AMANDA AYUMI IBARAKI STINE ” Practice Location

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