Healthcare Provider Details

I. General information

NPI: 1205189362
Provider Name (Legal Business Name): OLIVE TREE HEALING ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 156TH AVE NE
BELLEVUE WA
98007-3825
US

IV. Provider business mailing address

2018 156TH AVE NE
BELLEVUE WA
98007-3825
US

V. Phone/Fax

Practice location:
  • Phone: 425-920-8008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00009302
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60205940
License Number StateWA

VIII. Authorized Official

Name: KAREN GORRIN
Title or Position: OWNER
Credential:
Phone: 425-920-8008