Healthcare Provider Details

I. General information

NPI: 1932957610
Provider Name (Legal Business Name): ANGELA BOWEN BOSSUT LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S 5TH ST
TACOMA WA
98405-3742
US

IV. Provider business mailing address

1112 S 5TH ST
TACOMA WA
98405-3742
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-7926
  • Fax:
Mailing address:
  • Phone: 253-403-7926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61312923
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: