Provider Demographics
NPI:1720417298
Name:MASUDA, MAMI
Entity Type:Individual
Prefix:
First Name:MAMI
Middle Name:
Last Name:MASUDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21911 64TH AVE W STE 201
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2230
Mailing Address - Country:US
Mailing Address - Phone:425-236-2330
Mailing Address - Fax:
Practice Address - Street 1:21911 64TH AVE W STE 201
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2230
Practice Address - Country:US
Practice Address - Phone:425-236-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health