Sundus A Ali

Individual provider Active NPI Behavior Technician · Covington, WA

NPI 1922759166 · NPPES record last updated Jan 10, 2022

Key facts

NPI
1922759166
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
27023 164TH Ave SE
Covington, WA 98042-8241
Phone
(253) 639-7146
NPI assigned
Jan 10, 2022
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Mindsource Center, LLC Past
since Jan 21, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician
Group: 193400000X SINGLE SPECIALTY GROUP
106S00000X Yes

Addresses

Primary practice location

27023 164TH Ave SE
Covington, WA 98042-8241

Mailing address

21805 131St PL SE
Kent, WA 98031-2329
Phone (206) 679-3218

Other providers in Covington, WA

All providers in Covington, WA · Behavior Technician in Washington

Sources for this page

Verify at the official NPI Registry.