Provider Demographics
NPI:1366266926
Name:NAZARETH, ISABEL (LAC)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:NAZARETH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 NE 182ND PL
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-3521
Mailing Address - Country:US
Mailing Address - Phone:808-321-9481
Mailing Address - Fax:
Practice Address - Street 1:8612 NE 182ND PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-3521
Practice Address - Country:US
Practice Address - Phone:808-321-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18895101YM0800X
WA61490186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health