Provider Demographics
NPI:1619698297
Name:NAKANISHI, DEAN (LMHCA)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:NAKANISHI
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14029 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6469
Mailing Address - Country:US
Mailing Address - Phone:206-250-6582
Mailing Address - Fax:
Practice Address - Street 1:16300 112TH AVE NE BLDG A
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-1535
Practice Address - Country:US
Practice Address - Phone:425-954-3498
Practice Address - Fax:425-485-8369
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61315946101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health