Provider Demographics
NPI:1043882434
Name:POKKULURI, NIKHILA
Entity type:Individual
Prefix:MRS
First Name:NIKHILA
Middle Name:
Last Name:POKKULURI
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:NIKHILA
Other - Middle Name:
Other - Last Name:J
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MENTAL HEALTH COUNSE
Mailing Address - Street 1:9100 BRIDGEPORT WAY SE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:781-526-8595
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:9100 BRIDGEPORT WAY SE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-302-3826
Practice Address - Fax:206-901-2010
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1982800Medicaid