Healthcare Provider Details

I. General information

NPI: 1477462075
Provider Name (Legal Business Name): SENDERO COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 W RAILROAD AVE
SHELTON WA
98584-7813
US

IV. Provider business mailing address

312 STELLA CT NW
YELM WA
98597-6623
US

V. Phone/Fax

Practice location:
  • Phone: 253-354-3764
  • Fax: 253-354-7440
Mailing address:
  • Phone: 253-354-3764
  • Fax: 253-354-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILFREDO FERNANDEZ-FONSECA
Title or Position: FOUNDER AND CEO
Credential: LMHCA
Phone: 253-354-3764