Provider Demographics
NPI:1780043729
Name:KOMANAPALLI, VIGNAPANA (LMHC)
Entity Type:Individual
Prefix:
First Name:VIGNAPANA
Middle Name:
Last Name:KOMANAPALLI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 44TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4116
Mailing Address - Country:US
Mailing Address - Phone:206-657-4814
Mailing Address - Fax:206-657-4815
Practice Address - Street 1:4505 44TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4116
Practice Address - Country:US
Practice Address - Phone:206-657-4814
Practice Address - Fax:206-657-4815
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60588949101YM0800X
WALH61069216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2124870Medicaid