Provider Demographics
NPI:1093254351
Name:OCAMPO, ALFRED
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S GRADY WAY STE 249
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3209
Mailing Address - Country:US
Mailing Address - Phone:253-391-3913
Mailing Address - Fax:
Practice Address - Street 1:15 S GRADY WAY
Practice Address - Street 2:249
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3220
Practice Address - Country:US
Practice Address - Phone:253-229-9452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO 60665075101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)