Crystal Agoncillo – Counselor in Seattle, WA

Key facts

NPI: 1972184406
Entity type: Individual (NPI type 1)
Primary specialty: Counselor 101Y00000X
License: CG61165735 (WA)
Practice address: 2120 S Plum St Ste a
Seattle, WA 98144-4539
Phone: (206) 441-3043
NPI assigned: Apr 16, 2021
Sex: Female
Sole proprietor: No

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
CG61165735	WA	MD	Counselor

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Counselor	101Y00000X	CG61165735	WA	Yes

Addresses

Primary practice location

2120 S Plum St Ste a
Seattle, WA 98144-4539

Mailing address

222 Wall St
Ste 100
Seattle, WA 98121-1431

Other practice location 1

222 Wall St
Ste 100
Seattle, WA 98121-1431
Phone (206) 441-3043 ext. 5027

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 24, 2022.

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1972184406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 WALL ST",
            "address_2": "STE 100",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981211431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 S PLUM ST STE A",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981444539",
            "telephone_number": "206-441-3043"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 Wall St",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981211431",
            "country_code": "US",
            "telephone_number": "206-441-3043 x5027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGONCILLO",
        "first_name": "CRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG61165735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

All providers in Seattle, WA · Counselor in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.