Provider Demographics
NPI:1457129868
Name:ICHIMURA, EMI (LMHCA, MS, BA)
Entity Type:Individual
Prefix:
First Name:EMI
Middle Name:
Last Name:ICHIMURA
Suffix:
Gender:F
Credentials:LMHCA, MS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130A DEXTER AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2413
Mailing Address - Country:US
Mailing Address - Phone:510-461-4026
Mailing Address - Fax:
Practice Address - Street 1:338 NW 85TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3120
Practice Address - Country:US
Practice Address - Phone:206-659-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61458020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health