Healthcare Provider Details

I. General information

NPI: 1972352243
Provider Name (Legal Business Name): CONSEJO COUNSELING AND REFERRAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 SW 10TH ST
RENTON WA
98057-5223
US

IV. Provider business mailing address

723 SW 10TH ST
RENTON WA
98057-5223
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax: 206-461-6989
Mailing address:
  • Phone: 206-461-4880
  • Fax: 206-461-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANA BOSCHMA
Title or Position: IS DIRECTOR
Credential:
Phone: 206-461-4880