Basic Information
Provider Information
NPI: 1295316958
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAZI HAMEDANI
FirstName: PARISA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 944 DISCOVERY CIR NE UNIT 204
Address2:  
City: ISSAQUAH
State: WA
PostalCode: 980296204
CountryCode: US
TelephoneNumber: 4255033666
FaxNumber:  
Practice Location
Address1: 708 BROADWAY STE 170
Address2:  
City: TACOMA
State: WA
PostalCode: 984023778
CountryCode: US
TelephoneNumber: 2533486548
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/15/2021
LastUpdateDate: 04/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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