Provider Demographics
NPI:1093471823
Name:PARK, CHRISOTPHER JIN-SU (LMHCA)
Entity Type:Individual
Prefix:
First Name:CHRISOTPHER
Middle Name:JIN-SU
Last Name:PARK
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 14TH AVE W APT 7
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2051
Mailing Address - Country:US
Mailing Address - Phone:206-530-4821
Mailing Address - Fax:
Practice Address - Street 1:3035 14TH AVE W APT 7
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2051
Practice Address - Country:US
Practice Address - Phone:206-530-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60836325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health