Provider Demographics
NPI:1316009632
Name:NAKAYAMA, MICHAEL YUKIO (LICSW, GMHS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:YUKIO
Last Name:NAKAYAMA
Suffix:
Gender:M
Credentials:LICSW, GMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1550 N 115TH ST
Mailing Address - Street 2:MS: E-120
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8401
Mailing Address - Country:US
Mailing Address - Phone:206-368-1172
Mailing Address - Fax:206-368-1489
Practice Address - Street 1:1550 N 115TH ST
Practice Address - Street 2:MS: E-120
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8401
Practice Address - Country:US
Practice Address - Phone:206-368-1172
Practice Address - Fax:206-368-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047472101YP2500X
WALW00009568283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional