MEDICARE: CHILD'S PLACE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00007985	WA

General Provider Information

NPI Number	:	1093247413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD'S PLACE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 47031
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-7031
Country	:	US
Telephone Number	:	206-573-2734
Fax Number	:

Provider Business Practice Location Address
First Line	:	9929 SW BANK RD STE 202-A
Second Line	:
City	:	VASHON
State	:	WA
Zip	:	98070-5014
Country	:	US
Telephone Number	:	206-573-2734
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MARIE SOHL
Credential	:
Telephone Number	:	206-573-2734

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	11/24/2023

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