Provider Demographics
NPI:1124309075
Name:PROSPAL, JOHN JOSEPH (MA, LMHC, CMHS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:PROSPAL
Suffix:
Gender:M
Credentials:MA, LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 166TH AVE NE
Mailing Address - Street 2:BLOSSOM FAMILY WELLNESS, SUITE 202
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3999
Mailing Address - Country:US
Mailing Address - Phone:425-615-0622
Mailing Address - Fax:
Practice Address - Street 1:8105 166TH AVE NE
Practice Address - Street 2:BLOSSOM FAMILY WELLNESS, SUITE 202
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3999
Practice Address - Country:US
Practice Address - Phone:425-615-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60144538101Y00000X
WAMC60161534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor