Healthcare Provider Details

I. General information

NPI: 1063023752
Provider Name (Legal Business Name): NW TRANSFORMATIONS CHILD AND FAMILY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 57TH CT SE
LACEY WA
98513-4159
US

IV. Provider business mailing address

1420 MARVIN RD NE STE C
LACEY WA
98516-3878
US

V. Phone/Fax

Practice location:
  • Phone: 360-970-8356
  • Fax: 360-539-3332
Mailing address:
  • Phone: 360-634-9699
  • Fax: 360-539-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional 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: MS. BONNIE M EDWARDS
Title or Position: OWNER/MANAGER
Credential: LICSW
Phone: 360-634-9699