Healthcare Provider Details

I. General information

NPI: 1366351215
Provider Name (Legal Business Name): JULIE BERET VON KOSCHEMBAHR M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WINSLOW WAY E STE 180
BAINBRIDGE ISLAND WA
98110-2402
US

IV. Provider business mailing address

400 WINSLOW WAY E STE 180
BAINBRIDGE ISLAND WA
98110-2402
US

V. Phone/Fax

Practice location:
  • Phone: 206-678-0090
  • Fax:
Mailing address:
  • Phone: 206-678-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: