MEDICARE: PRACTICING ABUNDANCE LLC

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	LH 60478649	WA

General Provider Information

NPI Number	:	1477003572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRACTICING ABUNDANCE LLC

Provider Business Mailing Address
First Line	:	12360 LAKE CITY WAY NE
Second Line	:	SUITE 420
City	:	SEATTLE
State	:	WA
Zip	:	98125-5447
Country	:	US
Telephone Number	:	256-648-1730
Fax Number	:	206-363-9639

Provider Business Practice Location Address
First Line	:	5355 TALLMAN AVE NW
Second Line	:	#210
City	:	SEATTLE
State	:	WA
Zip	:	98107-3935
Country	:	US
Telephone Number	:	256-648-1730
Fax Number	:

Authorized Official
Title or Position	:	LICENSED MENTAL HEALTH COUNSELOR
Name	:	MS. ROSEMARY ELAINE CRAWFORD
Credential	:	MA, LMHC
Telephone Number	:	256-648-1730

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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