Provider Demographics
NPI:1467083550
Name:ITICHA, YOSEPH SAQATA
Entity Type:Individual
Prefix:
First Name:YOSEPH
Middle Name:SAQATA
Last Name:ITICHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:YOSEPH
Other - Middle Name:SAQATA
Other - Last Name:ITICHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 SW HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3505
Mailing Address - Country:US
Mailing Address - Phone:206-257-6922
Mailing Address - Fax:206-257-6828
Practice Address - Street 1:2600 SW HOLDEN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3505
Practice Address - Country:US
Practice Address - Phone:206-257-6922
Practice Address - Fax:206-257-6828
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health