Healthcare Provider Details

I. General information

NPI: 1942922802
Provider Name (Legal Business Name): THE TRAUMA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/17/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 AGATE PASS RD NE
BAINBRIDGE ISLAND WA
98110-1035
US

IV. Provider business mailing address

16150 AGATE PASS RD NE
BAINBRIDGE ISLAND WA
98110-1035
US

V. Phone/Fax

Practice location:
  • Phone: 760-492-6444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER RUTGERS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 760-492-6444