Basic Information
| Provider Information | |||||||||
| NPI: | 1417219478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDULMUMIN | ||||||||
| FirstName: | BASHIIR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 SOUTHCENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | TUKWILA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981882547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069012000 | ||||||||
| FaxNumber: | 2069012010 | ||||||||
| Practice Location | |||||||||
| Address1: | 14270 NE 21ST ST # 98007 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980073720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256535000 | ||||||||
| FaxNumber: | 4256535010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP60238968 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.