Provider Demographics
NPI:1174925556
Name:KOBERSTEIN, DEONA
Entity type:Individual
Prefix:
First Name:DEONA
Middle Name:
Last Name:KOBERSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13703
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-1703
Mailing Address - Country:US
Mailing Address - Phone:206-659-8505
Mailing Address - Fax:
Practice Address - Street 1:15833 MILL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1200
Practice Address - Country:US
Practice Address - Phone:206-659-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61132942101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health