Healthcare Provider Details

I. General information

NPI: 1578187829
Provider Name (Legal Business Name): THERAPY NORTHWEST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22525 SE 64TH PL STE 2277
ISSAQUAH WA
98027-5383
US

IV. Provider business mailing address

22525 SE 64TH PL STE 2277
ISSAQUAH WA
98027-5383
US

V. Phone/Fax

Practice location:
  • Phone: 360-930-9380
  • Fax: 425-278-7765
Mailing address:
  • Phone: 360-930-9380
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MASTERS
Title or Position: MEMBER
Credential: MA LMHC
Phone: 425-449-3466