Healthcare Provider Details

I. General information

NPI: 1558427120
Provider Name (Legal Business Name): CONFIDENTIAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10017 251ST ST E
GRAHAM WA
98338-7075
US

IV. Provider business mailing address

PO BOX 354
GRAHAM WA
98338-0354
US

V. Phone/Fax

Practice location:
  • Phone: 253-597-8022
  • Fax:
Mailing address:
  • Phone: 253-597-8022
  • 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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIC KARL MILLER
Title or Position: OWNER
Credential: LMHC
Phone: 253-597-8022