Provider Demographics
NPI:1609541911
Name:TAHER, NICOLE B (MFTA, MHCA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:TAHER
Suffix:
Gender:F
Credentials:MFTA, MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SW TRENTON ST # 1019
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3206
Mailing Address - Country:US
Mailing Address - Phone:310-773-4781
Mailing Address - Fax:
Practice Address - Street 1:2720 49TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:310-773-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61187076101YM0800X
WA61186885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health