Provider Demographics
NPI:1649024092
Name:NAYELI, LIESL
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:
Last Name:NAYELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIESL
Other - Middle Name:
Other - Last Name:KINGSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19426 SE 128TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-8739
Mailing Address - Country:US
Mailing Address - Phone:808-277-1331
Mailing Address - Fax:
Practice Address - Street 1:621 PACIFIC AVE STE 300
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4611
Practice Address - Country:US
Practice Address - Phone:808-277-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist