Provider Demographics
NPI:1790240471
Name:NAKANISHI, TREY MATTHEW
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:MATTHEW
Last Name:NAKANISHI
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 1:24842 SE 278TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-2019
Mailing Address - Country:US
Mailing Address - Phone:206-949-6321
Mailing Address - Fax:
Practice Address - Street 1:14434 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4146
Practice Address - Country:US
Practice Address - Phone:425-223-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst