Provider Demographics
NPI:1659188738
Name:KORNGOLD, MIRIAM (LMHCA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:KORNGOLD
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 N 45TH ST STE 311
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6979
Mailing Address - Country:US
Mailing Address - Phone:425-341-9618
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 311
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6979
Practice Address - Country:US
Practice Address - Phone:425-341-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61610463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health