Provider Demographics
NPI:1659672863
Name:HOLISTIC FAMILY WELLNESS CLINIC
Entity Type:Organization
Organization Name:HOLISTIC FAMILY WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATH
Authorized Official - Prefix:
Authorized Official - First Name:AKIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KATO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:206-853-1242
Mailing Address - Street 1:1900 116TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 116TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3013
Practice Address - Country:US
Practice Address - Phone:425-954-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60184218175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty