Healthcare Provider Details

I. General information

NPI: 1104529510
Provider Name (Legal Business Name): MAUREEN ZACH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 112TH AVE NE STE 302
BELLEVUE WA
98004-5800
US

IV. Provider business mailing address

PO BOX 1098
DALLAS NC
28034-1098
US

V. Phone/Fax

Practice location:
  • Phone: 425-939-6856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEANETTE JOHNSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 727-800-2332