Provider Demographics
NPI:1578359824
Name:OMURA-MILLER, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:OMURA-MILLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:OMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8720 172ND ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2272
Mailing Address - Country:US
Mailing Address - Phone:253-298-8011
Mailing Address - Fax:
Practice Address - Street 1:5620 112TH ST E STE 215
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3206
Practice Address - Country:US
Practice Address - Phone:253-446-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61644026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist