MEDICARE: FAMILY FOUNDATIONS COUNSELING

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	106H00000X	Marriage & Family Therapist	LF00002076	WA

General Provider Information

NPI Number	:	1528306057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FOUNDATIONS COUNSELING

Provider Business Mailing Address
First Line	:	6512 20TH STREET CT W
Second Line	:	STE. B
City	:	FIRCREST
State	:	WA
Zip	:	98466-6212
Country	:	US
Telephone Number	:	253-566-5559
Fax Number	:	253-565-0274

Provider Business Practice Location Address
First Line	:	6512 20TH STREET CT W
Second Line	:	STE. B
City	:	FIRCREST
State	:	WA
Zip	:	98466-6212
Country	:	US
Telephone Number	:	253-566-5559
Fax Number	:	253-565-0274

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	BRIAN R. TINGLEY
Credential	:	MS, LMFT
Telephone Number	:	253-566-5559

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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