Provider Demographics
NPI:1255767562
Name:KIM, LORA IVANOVA (LMHC, MHP, NCC)
Entity type:Individual
Prefix:MISS
First Name:LORA
Middle Name:IVANOVA
Last Name:KIM
Suffix:
Gender:F
Credentials:LMHC, MHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9572
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:888-232-0222
Mailing Address - Fax:
Practice Address - Street 1:226 SUMMIT AVE E STE 25
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5619
Practice Address - Country:US
Practice Address - Phone:206-536-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health