Healthcare Provider Details

I. General information

NPI: 1841651585
Provider Name (Legal Business Name): BEAUTIFUL AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17825 59TH AVE NE STE B
ARLINGTON WA
98223-6453
US

IV. Provider business mailing address

17825 59TH AVE NE STE B
ARLINGTON WA
98223-6453
US

V. Phone/Fax

Practice location:
  • Phone: 360-363-4234
  • Fax: 360-363-4235
Mailing address:
  • Phone: 360-363-4234
  • Fax: 360-363-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60590118
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACEY LYNN WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 360-363-4234