Basic Information
| Provider Information | |||||||||
| NPI: | 1174040992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONGHA | ||||||||
| FirstName: | TRINITY | ||||||||
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| Credential: | MFTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2818 QUEENS WAY APT 1A | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983547014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808788700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3560 BRIDGEPORT WAY W STE 2C | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MG61327319 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 225700000X | MA60769361 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | MG61327319 | 01 | WA | LMFTA | OTHER | MA60769361 | 01 | WA | LMT | OTHER |