Provider Demographics
NPI:1326707712
Name:KI, SEOL (LMSW)
Entity Type:Individual
Prefix:
First Name:SEOL
Middle Name:
Last Name:KI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 N SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7488
Mailing Address - Country:US
Mailing Address - Phone:480-259-0305
Mailing Address - Fax:
Practice Address - Street 1:633 E RAY RD STE 131
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4206
Practice Address - Country:US
Practice Address - Phone:480-630-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19966101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor