Provider Demographics
NPI:1902955016
Name:BOJANG, KEBBA MB (MHT, RC)
Entity Type:Individual
Prefix:MR
First Name:KEBBA
Middle Name:MB
Last Name:BOJANG
Suffix:
Gender:M
Credentials:MHT, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SEATTLE MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:8705 166TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3749
Practice Address - Country:US
Practice Address - Phone:425-653-5080
Practice Address - Fax:425-653-5081
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60117493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health