Healthcare Provider Details

I. General information

NPI: 1598134595
Provider Name (Legal Business Name): THIS TOO SHALL PASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2015
Last Update Date: 09/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 MICKELBERRY RD NW STE 137
SILVERDALE WA
98383-8309
US

IV. Provider business mailing address

PO BOX 5828
BREMERTON WA
98312-0596
US

V. Phone/Fax

Practice location:
  • Phone: 888-868-6952
  • Fax:
Mailing address:
  • Phone: 360-809-2971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60107671
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF 60300097
License Number StateWA

VIII. Authorized Official

Name: MS. CHRISTINE ELLEN PUEBLA
Title or Position: THERAPIST
Credential: LMFT, CMHS
Phone: 360-809-2971