Healthcare Provider Details

I. General information

NPI: 1205156338
Provider Name (Legal Business Name): CONSEJO COUNSELING AND REFERRAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 ORCHARD ST W
TACOMA WA
98467-3824
US

IV. Provider business mailing address

723 SW 10TH ST
RENTON WA
98057-5223
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-4880
  • Fax: 206-461-6989
Mailing address:
  • Phone: 206-461-4880
  • Fax: 206-461-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number037
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number037
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number037
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number037
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANA BOSCHMA
Title or Position: IS DIRECTOR
Credential:
Phone: 206-461-4880