Healthcare Provider Details

I. General information

NPI: 1215232764
Provider Name (Legal Business Name): ARIEL BLANCHE KOFOED MA, LMFT, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ARIEL BLANCHE VANMECHELEN BA

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 10/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 BRIDGEPORT WAY W SUITE D3
UNIVERSITY PLACE WA
98466
US

IV. Provider business mailing address

6824 19TH ST W # 281
UNIVERSITY PLACE WA
98466-5528
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-4450
  • Fax: 253-444-0543
Mailing address:
  • Phone: 253-564-4450
  • Fax: 253-444-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60288349
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60535747
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: