Provider Demographics
NPI:1326810391
Name:MAZILU, SIMONE ALEXIS (CBT)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:ALEXIS
Last Name:MAZILU
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 112TH AVE NE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-754-5135
Mailing Address - Fax:
Practice Address - Street 1:1380 112TH AVE NE
Practice Address - Street 2:SUITE 206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3759
Practice Address - Country:US
Practice Address - Phone:719-201-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician