Provider Demographics
NPI:1699408047
Name:TAONE, TREVOR EIJI
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:EIJI
Last Name:TAONE
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 1:4540 ISLAND CREST WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4444
Mailing Address - Country:US
Mailing Address - Phone:808-225-4883
Mailing Address - Fax:
Practice Address - Street 1:4540 ISLAND CREST WAY
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4444
Practice Address - Country:US
Practice Address - Phone:808-225-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61314271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health