Provider Demographics
NPI:1528802683
Name:MOHAN, MAYA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 210TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-6614
Mailing Address - Country:US
Mailing Address - Phone:425-442-6055
Mailing Address - Fax:
Practice Address - Street 1:711 CAPITOL WAY S STE 204
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1267
Practice Address - Country:US
Practice Address - Phone:608-433-9736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3278276171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach