MEDICARE: A POSITIVE CHANGE

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	251S00000X	Community/Behavioral Health Agency	LH60429375	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LH60429375	OTHER	WA	LMHC LH60429375

General Provider Information

NPI Number	:	1144616848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A POSITIVE CHANGE

Provider Business Mailing Address
First Line	:	5262 OLYMPIC DRIVE SUITE C
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335
Country	:	US
Telephone Number	:	253-225-2275
Fax Number	:

Provider Business Practice Location Address
First Line	:	5262 OLYMPIC DRIVE SUITE C
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335
Country	:	US
Telephone Number	:	253-225-2275
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. AMANDA ANNA BOLEY PSYD
Credential	:	LMHC
Telephone Number	:	253-225-2275

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	04/09/2015

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Directions to “A POSITIVE CHANGE ” Practice Location

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