Provider Demographics
NPI:1629653290
Name:OMARE, ROBERT OMWANDO
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:OMWANDO
Last Name:OMARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34230 1ST PL S APT D
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4424
Mailing Address - Country:US
Mailing Address - Phone:206-825-4032
Mailing Address - Fax:
Practice Address - Street 1:7224 PACIFIC HWY E
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9654
Practice Address - Country:US
Practice Address - Phone:253-220-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60910262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health