Healthcare Provider Details

I. General information

NPI: 1942625868
Provider Name (Legal Business Name): PAULA M ROVIK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 NW LINDVIG WAY SUITE 6
POULSBO WA
98370-6520
US

IV. Provider business mailing address

21870 APOLLO DR NE
POULSBO WA
98370-6707
US

V. Phone/Fax

Practice location:
  • Phone: 360-813-5502
  • Fax:
Mailing address:
  • Phone: 360-813-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60365013
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: