Provider Demographics
NPI:1720578156
Name:KAMATCHO, IRINA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KAMATCHO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 162ND CT NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3079
Mailing Address - Country:US
Mailing Address - Phone:425-274-6504
Mailing Address - Fax:
Practice Address - Street 1:22605 SE 56TH ST STE 150
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5212
Practice Address - Country:US
Practice Address - Phone:425-686-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60434245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health