Provider Demographics
NPI:1023353141
Name:ITO, TOMOMI (MA, LMHC, CDP)
Entity type:Individual
Prefix:
First Name:TOMOMI
Middle Name:
Last Name:ITO
Suffix:
Gender:F
Credentials:MA, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7981 168TH AVE NE STE 138
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0911
Mailing Address - Country:US
Mailing Address - Phone:425-588-7046
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:7981 168TH AVE NE STE 138
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0911
Practice Address - Country:US
Practice Address - Phone:425-588-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60214472101YA0400X
101YM0800X
WALH60914208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)