Healthcare Provider Details

I. General information

NPI: 1639045107
Provider Name (Legal Business Name): TAHOMAGLOW HEALING AND THERAPY COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 NW MARKET ST STE 502
SEATTLE WA
98107-4098
US

IV. Provider business mailing address

1501 NW 56TH ST APT 518
SEATTLE WA
98107-5288
US

V. Phone/Fax

Practice location:
  • Phone: 206-804-2122
  • Fax: 206-970-5463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELA GUADALUPE GUERRERO
Title or Position: OWNER
Credential: LMHC
Phone: 206-804-2122