Healthcare Provider Details

I. General information

NPI: 1851800437
Provider Name (Legal Business Name): THE GOOD LIFE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 REGENTS BLVD STE 101
FIRCREST WA
98466-6089
US

IV. Provider business mailing address

1033 REGENTS BLVD STE 101
FIRCREST WA
98466-6089
US

V. Phone/Fax

Practice location:
  • Phone: 253-238-6554
  • Fax: 253-590-0821
Mailing address:
  • Phone: 253-238-6554
  • Fax: 253-590-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW60200313
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60123442
License Number StateWA

VIII. Authorized Official

Name: KARIAH C PHILLIPS
Title or Position: CO-OWNER/THERAPIST
Credential: LICSW
Phone: 253-238-6554