Provider Demographics
NPI:1689212391
Name:PARK-SARGENT, OLIVIA (LMFT, PMH-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PARK-SARGENT
Suffix:
Gender:F
Credentials:LMFT, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5004
Mailing Address - Country:US
Mailing Address - Phone:206-354-7599
Mailing Address - Fax:
Practice Address - Street 1:802 29TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5004
Practice Address - Country:US
Practice Address - Phone:206-354-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61495113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist