Basic Information
| Provider Information | |||||||||
| NPI: | 1528296761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHU | ||||||||
| FirstName: | BOHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3639 MARTIN LUTHER KING JR WAY S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981446847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067742445 | ||||||||
| FaxNumber: | 2066957606 | ||||||||
| Practice Location | |||||||||
| Address1: | 3639 MARTIN LUTHER KING JR WAY S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981446847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067742445 | ||||||||
| FaxNumber: | 2066957606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 06/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | RC00056294 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | RC00056294 | WA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.