Healthcare Provider Details

I. General information

NPI: 1114651130
Provider Name (Legal Business Name): MARIPOSA COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19125 N CREEK PKWY STE 149
BOTHELL WA
98011-8018
US

IV. Provider business mailing address

19125 N CREEK PKWY STE 149
BOTHELL WA
98011-8018
US

V. Phone/Fax

Practice location:
  • Phone: 425-364-9796
  • Fax:
Mailing address:
  • Phone: 425-364-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1235566886
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: MRS. NORA RILEY FARAM
Title or Position: OWNER
Credential: LICSW
Phone: 425-364-9796