Healthcare Provider Details

I. General information

NPI: 1497266514
Provider Name (Legal Business Name): A NEW BEGINNING FAMILY & TRAUMA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14705 MERIDIAN E
PUYALLUP WA
98375
US

IV. Provider business mailing address

14705 MERIDIAN E
PUYALLUP WA
98375-6626
US

V. Phone/Fax

Practice location:
  • Phone: 206-693-1888
  • Fax: 253-446-7458
Mailing address:
  • Phone: 253-583-6549
  • Fax: 253-446-7458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number60628193
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number60628193
License Number StateWA

VIII. Authorized Official

Name: ROBERT EDWARD CERKA
Title or Position: OWNER
Credential: MA
Phone: 206-693-1888