Provider Demographics
NPI:1235423781
Name:WATANABE, HARUKO (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:HARUKO
Middle Name:
Last Name:WATANABE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:HARUKO
Other - Middle Name:
Other - Last Name:CHOOSAKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 SW 136TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1214
Practice Address - Country:US
Practice Address - Phone:253-257-6600
Practice Address - Fax:206-257-6830
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60206015101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling