MEDICARE: THE GOOD LIFE INSTITUTE, 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	106H00000X	Marriage & Family Therapist	LF60123442	WA
2	101YM0800X	Mental Health Counselor	LW60200313	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316128523	OTHER	WA	NPI
2	1649450313	OTHER	WA	NPI

General Provider Information

NPI Number	:	1851800437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GOOD LIFE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	1033 REGENTS BLVD STE 101
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6089
Country	:	US
Telephone Number	:	253-238-6554
Fax Number	:	253-590-0821

Provider Business Practice Location Address
First Line	:	1033 REGENTS BLVD STE 101
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6089
Country	:	US
Telephone Number	:	253-238-6554
Fax Number	:	253-590-0821

Authorized Official
Title or Position	:	CO-OWNER/THERAPIST
Name	:	KARIAH C PHILLIPS
Credential	:	LICSW
Telephone Number	:	253-238-6554

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	07/21/2022

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Directions to “THE GOOD LIFE INSTITUTE, LLC ” Practice Location

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