Provider Demographics
NPI:1114314085
Name:MORINA, PHILLIP THOMAS (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:THOMAS
Last Name:MORINA
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 4TH AVE N APT 44
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4236
Mailing Address - Country:US
Mailing Address - Phone:360-623-3126
Mailing Address - Fax:
Practice Address - Street 1:718 4TH AVE N APT 44
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4236
Practice Address - Country:US
Practice Address - Phone:360-623-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-18
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60483234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist