Active NPI
Miyuki Tomura, PHD
- Mental Health Counselor
- Seattle, WA
National Provider Identifier
1710163308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MHC-899-0
- Practice address
- 3639 Martin Luther King Jr Way S
Seattle, WA 98144-6847 - Phone
- (206) 805-8965
- NPI assigned
- Jan 14, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY60257713 | WA | |
| Mental Health Counselor | 101YM0800X | MHC-899-0 | HI | Primary |
Addresses
Primary practice location
3639 Martin Luther King Jr Way S
Seattle, WA 98144-6847
Mailing address
3035 Island Crest Way
Suite 108
Mercer Island, WA 98040-2919
Phone (425) 677-4146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 1, 2020 through Dec 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MHC-899-0 | HI | MD | Mental Health Counselor |
| PY60257713 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200268800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1710163308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3035 ISLAND CREST WAY",
"address_2": "SUITE 108",
"city": "MERCER ISLAND",
"state": "WA",
"postal_code": "980402919",
"telephone_number": "425-677-4146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3639 MARTIN LUTHER KING JR WAY S",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981446847",
"telephone_number": "206-805-8965"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOMURA",
"first_name": "MIYUKI",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-14",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60257713",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "HI",
"license": "MHC-899-0",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.