Healthcare Provider Details

I. General information

NPI: 1194459115
Provider Name (Legal Business Name): SEA CHANGE THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22525 MARINE VIEW DR S STE 200
DES MOINES WA
98198-6879
US

IV. Provider business mailing address

22525 MARINE VIEW DR S STE 200
DES MOINES WA
98198-6879
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-3060
  • Fax:
Mailing address:
  • Phone: 206-705-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNY COOKE MALSTROM
Title or Position: OWNER
Credential:
Phone: 206-705-3060