Healthcare Provider Details

I. General information

NPI: 1578886404
Provider Name (Legal Business Name): EILEEN DORIS WURST LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2010
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST STE 208
SEATTLE WA
98103-8889
US

IV. Provider business mailing address

7709 8TH AVE SW
SEATTLE WA
98106-2007
US

V. Phone/Fax

Practice location:
  • Phone: 206-947-7687
  • Fax:
Mailing address:
  • Phone: 206-947-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH60148443
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60148443
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60148443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: