Healthcare Provider Details

I. General information

NPI: 1760702807
Provider Name (Legal Business Name): ABRAXAS COUNSELING & CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7926 SE PROMENADE LN
PORT ORCHARD WA
98367-9751
US

IV. Provider business mailing address

PO BOX 1586
PORT ORCHARD WA
98366-0140
US

V. Phone/Fax

Practice location:
  • Phone: 360-871-2800
  • Fax: 360-871-3401
Mailing address:
  • Phone: 360-871-2800
  • Fax: 360-871-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAP30004799
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP30004799
License Number StateWA

VIII. Authorized Official

Name: RACHEL L BURGETT
Title or Position: PROVIDER
Credential: ARNP, CS
Phone: 360-871-2800