Provider Demographics
NPI:1417322769
Name:HO, LUISA CHIN-CHONG
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:CHIN-CHONG
Last Name:HO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0502
Mailing Address - Fax:206-764-0516
Practice Address - Street 1:5007 CLAREMONT WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-3321
Practice Address - Country:US
Practice Address - Phone:425-609-5504
Practice Address - Fax:425-609-5506
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60897417101Y00000X, 101YM0800X
390200000X
WALH61162141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111524501Medicaid