Healthcare Provider Details

I. General information

NPI: 1558955641
Provider Name (Legal Business Name): ALL THAT I AM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30412 3RD PL S
FEDERAL WAY WA
98003-4006
US

IV. Provider business mailing address

4301 S PINE ST STE 92
TACOMA WA
98409-7259
US

V. Phone/Fax

Practice location:
  • Phone: 253-268-6034
  • Fax:
Mailing address:
  • Phone: 253-617-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TRENECSIA WILSON
Title or Position: OWNER
Credential: LMHC
Phone: 253-268-6034