Provider Demographics
NPI:1548735707
Name:PALACIOS CAMPOS, VICTOR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:PALACIOS CAMPOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27025 48TH PL S APT L304
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-6266
Mailing Address - Country:US
Mailing Address - Phone:206-200-3119
Mailing Address - Fax:
Practice Address - Street 1:27025 48TH PL S APT L304
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6266
Practice Address - Country:US
Practice Address - Phone:206-200-3119
Practice Address - Fax:253-243-3192
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60894074101YM0800X
WALH61071652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health