Healthcare Provider Details

I. General information

NPI: 1720902125
Provider Name (Legal Business Name): BODHI COUNSELING AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST STE R
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

100 N HOWARD ST STE R
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 206-681-2072
  • Fax:
Mailing address:
  • Phone: 206-681-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DESHIKA BODHI JACKSON
Title or Position: MENTAL HEALTH THERAPIST
Credential: LICSW
Phone: 818-472-4469