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General NPI Number Information
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NPI Number | 1003261991
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Entity Type | Organization
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Legal Business Name | WHIDBEY ISLAND THERAPY CENTER
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 5548 MYRTLE AVE STE 101
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City | FREELAND
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State | WA
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Zip | 98249-8776
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Country | US
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Telephone | 360-969-9722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1579
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City | FREELAND
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State | WA
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Zip | 98249-1579
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Country | US
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Telephone | 360-969-9722
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Fax |
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Authorized Official
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Title or Position | EX. DIRECTOR
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Name | MS. SUSAN HOUCK STROM
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Credential | LMFT, ATR
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Telephone | 310-722-7063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 60474081
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License Number State | WA
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