Healthcare Provider Details

I. General information

NPI: 1255092920
Provider Name (Legal Business Name): CQ THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19125 NORTH CREEK PARKWAY #123B
BOTHELL WA
98011
US

IV. Provider business mailing address

130 2ND AVE N UNIT 1712
EDMONDS WA
98020-2121
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-7264
  • Fax:
Mailing address:
  • Phone: 425-954-7264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GINGER MICHEL
Title or Position: OWNER
Credential: LMHC, CMHS
Phone: 425-954-7264