NPIMap

Organization Active NPI

Optimallife Wellness Center

  • Marriage & Family Therapist
  • Bellevue, WA
National Provider Identifier
1851417810
Registry record updated Mar 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LF00001767 Issued in WA
Legal business name
OPTIMALLIFE WELLNESS CENTER
Practice address
2320 130TH Ave NE Ste 240
Bellevue, WA 98005-1718
Phone
(425) 646-2778
Fax
(425) 453-6377
NPI assigned
Mar 21, 2007
Last updated
Mar 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2025

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

Authorized official

Name
Ms. Lara K Symonds, MANPI 1205952264
Title
Owner
Phone
(206) 459-5987

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X LF00001767 WA Primary

Addresses

Primary practice location

2320 130TH Ave NE Ste 240
Bellevue, WA 98005-1718

Mailing address

2320 130TH Ave NE Ste 240
Bellevue, WA 98005-1718
Phone (425) 598-7132

Other identifiers 3

IdentifierTypeStateIssuer
708715000OtherMAGELLAN
11644468OtherCAQH
306139956OtherUBH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240313002850 WA Part B Supplier - Clinic/Group Practice 1456797398 Receives reassigned benefits from 1 practitioner
Practice locations: Bellevue, WA

National Provider Directory

National Provider Directory

Locations

1603 116th Ave NE
Ste 114
Bellevue, WA 98004
Phone (425) 444-7187

2320 130th Ave NE
Ste 240
Bellevue, WA 98005
Phone (425) 646-2778

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1851417810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 130TH AVE NE STE 240",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051718",
            "telephone_number": "425-598-7132",
            "fax_number": "425-453-6377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 130TH AVE NE STE 240",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980051718",
            "telephone_number": "425-646-2778",
            "fax_number": "425-453-6377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMALLIFE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-03",
        "status": "A",
        "authorized_official_last_name": "SYMONDS",
        "authorized_official_first_name": "LARA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-459-5987",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF00001767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "708715000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11644468",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "306139956",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.