Healthcare Provider Details

I. General information

NPI: 1275025595
Provider Name (Legal Business Name): PENINSULA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 WEST BELL ST SUITE D
SEQUIM WA
98382
US

IV. Provider business mailing address

435 WEST BELL ST SUITE D
SEQUIM WA
98382
US

V. Phone/Fax

Practice location:
  • Phone: 360-797-1429
  • Fax: 360-477-4939
Mailing address:
  • Phone: 360-797-1429
  • Fax: 360-477-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHELLEY HUNTINGTON
Title or Position: ADMINISTRATION OFFICER
Credential:
Phone: 360-797-1429