Basic Information
| Provider Information | |||||||||
| NPI: | 1134719123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSMAN | ||||||||
| FirstName: | MISKI | ||||||||
| MiddleName: | B | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907B THOMAS AVE SW | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980572931 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6201 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984087423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533638853 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2021 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG61128094 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MG61246598 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.