Provider Demographics
NPI:1265899181
Name:SAURI, MARCOS (CP60010877)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:SAURI
Suffix:
Gender:M
Credentials:CP60010877
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 SW 358TH COURT
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023
Mailing Address - Country:US
Mailing Address - Phone:253-397-7384
Mailing Address - Fax:
Practice Address - Street 1:1904 SW 358TH COURT
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023
Practice Address - Country:US
Practice Address - Phone:253-397-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60010877101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1568529543Medicaid