Individual provider Active NPI

Miyuki Tomura, PHD

  • Mental Health Counselor
  • Seattle, WA
National Provider Identifier
1710163308
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MHC-899-0 Issued in HI
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

Updated by the provider on Apr 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
MHC-899-0HIMDMental Health Counselor
PY60257713WAMDClinical 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

Verify at the official NPI Registry.