Healthcare Provider Details

I. General information

NPI: 1407881956
Provider Name (Legal Business Name): CENTER FOR TRANSPERSONAL DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 MOUNT BAKER RD SUITE B208
EASTSOUND WA
98245-8931
US

IV. Provider business mailing address

PO BOX 363
EASTSOUND WA
98245-0363
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-6181
  • Fax: 360-376-6182
Mailing address:
  • Phone: 360-376-6181
  • Fax: 360-376-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAP30006672
License Number StateWA

VIII. Authorized Official

Name: ANNE MARIE GRESHAM
Title or Position: CO-OWNER
Credential: A.R.N.P.
Phone: 360-376-6181