Provider Demographics
NPI:1134874399
Name:ADSITT, MYLENE
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:
Last Name:ADSITT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 3RD AVE UNIT 738
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1745
Mailing Address - Country:US
Mailing Address - Phone:315-283-2208
Mailing Address - Fax:
Practice Address - Street 1:7902 168TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4445
Practice Address - Country:US
Practice Address - Phone:425-996-8592
Practice Address - Fax:425-968-5619
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61269939101YM0800X, 104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker