Provider Demographics
NPI:1316118003
Name:VERGARA, DAISY S (MS, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:S
Last Name:VERGARA
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:SURJO
Other - Last Name:VERGARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, NCC, LMHC
Mailing Address - Street 1:23515 NE NOVELTY HILL RD STE B221-159
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-1996
Mailing Address - Country:US
Mailing Address - Phone:425-686-9509
Mailing Address - Fax:
Practice Address - Street 1:22500 SE 64TH PL STE G-150
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8111
Practice Address - Country:US
Practice Address - Phone:425-686-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-179101YM0800X
TX65961101YP2500X
WALH-60428413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional