Provider Demographics
NPI:1417229261
Name:BAE, VIVIENNE (LMHC)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 MARTIN LUTHER KING JR. WAY S.
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:206-805-8914
Mailing Address - Fax:
Practice Address - Street 1:655 156TH AVE SE STE 255
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5018
Practice Address - Country:US
Practice Address - Phone:206-695-7511
Practice Address - Fax:206-695-7606
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health