Provider Demographics
NPI:1215332689
Name:ESTADILLA, KATHARINE SIMBULAN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:SIMBULAN
Last Name:ESTADILLA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5713
Mailing Address - Country:US
Mailing Address - Phone:206-601-4148
Mailing Address - Fax:
Practice Address - Street 1:631 STRANDER BLVD
Practice Address - Street 2:BUILDING A, SUITE G
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2963
Practice Address - Country:US
Practice Address - Phone:206-601-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60630071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health