Provider Demographics
NPI:1013490184
Name:PRADO LOPEZ ARISTI, FERNANDA GABRIELA (LMFTA)
Entity Type:Individual
Prefix:
First Name:FERNANDA
Middle Name:GABRIELA
Last Name:PRADO LOPEZ ARISTI
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17616 SE 186TH WAY
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9543
Mailing Address - Country:US
Mailing Address - Phone:206-294-9695
Mailing Address - Fax:
Practice Address - Street 1:17616 SE 186TH WAY
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9543
Practice Address - Country:US
Practice Address - Phone:206-294-9695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61041174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist