Provider Demographics
NPI:1801278569
Name:PARRA, GUSTAVO A (MFTLF60560674)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:A
Last Name:PARRA
Suffix:
Gender:M
Credentials:MFTLF60560674
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 THORNDYKE AVE W APT 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3529
Mailing Address - Country:US
Mailing Address - Phone:603-422-3508
Mailing Address - Fax:
Practice Address - Street 1:2200 THORNDYKE AVE W APT 206
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3529
Practice Address - Country:US
Practice Address - Phone:603-422-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMFT.LF.60560674101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health