Healthcare Provider Details

I. General information

NPI: 1740500438
Provider Name (Legal Business Name): NEUROFEEDBACK AND COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17921 BOTHELL EVERETT HWY STE 101
BOTHELL WA
98012-0013
US

IV. Provider business mailing address

17921 BOTHELL EVERETT HWY STE 101
BOTHELL WA
98012-0013
US

V. Phone/Fax

Practice location:
  • Phone: 524-610-9241
  • Fax: 425-806-4600
Mailing address:
  • Phone: 524-620-9241
  • Fax: 258-064-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3955-P
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEATRIZ ROSKOPF
Title or Position: OWNER
Credential: LICSW
Phone: 425-610-9241