Healthcare Provider Details

I. General information

NPI: 1821365974
Provider Name (Legal Business Name): ISLAND COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 WONN RD #C202
GREENBANK WA
98253-6422
US

IV. Provider business mailing address

PO BOX 881
FREELAND WA
98249-0881
US

V. Phone/Fax

Practice location:
  • Phone: 360-544-2245
  • Fax: 360-321-5697
Mailing address:
  • Phone: 360-544-2245
  • Fax: 360-321-5697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWA

VIII. Authorized Official

Name: MRS. LOIS MARYANNE HAYNES
Title or Position: PRESIDENT
Credential: LMHC
Phone: 360-544-2245