Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY00003684 | WA |
Y | 103TC0700X | Clinical Psychologist | PY00003684 | WA |
NPI | 1003959891 |
---|---|
Provider Name | Makiko Guji |
First Address | Gig Harbor, WA 98335-8330 |
Second Address | Lakewood, WA 98499-4470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 06/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PY00003684 | WA STATE LICENSE (01) | WA |