Healthcare Provider Details

I. General information

NPI: 1164296828
Provider Name (Legal Business Name): FLYING BAGEL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 4TH ST STE 7
BREMERTON WA
98337-1401
US

IV. Provider business mailing address

509 4TH ST STE 7
BREMERTON WA
98337-1401
US

V. Phone/Fax

Practice location:
  • Phone: 360-620-3402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARY ROSE DEWALD
Title or Position: OWNER/THERAPIST
Credential: LICSW
Phone: 360-990-3505