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General NPI Number Information
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NPI Number | 1033367131
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Entity Type | Organization
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Legal Business Name | CREATIVE CHANGE COUNSELING
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1600 DEXTER AVE N SUITE C-5
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City | SEATTLE
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State | WA
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Zip | 98109-3079
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Country | US
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Telephone | 206-782-5348
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Fax | 206-706-5356
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Provider Business Mailing Address
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Address Line | 1600 DEXTER AVE N. SUITE C-5
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City | SEATTLE
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State | WA
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Zip | 98109
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Country | US
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Telephone | 206-782-5348
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Fax | 206-706-5356
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Authorized Official
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Title or Position | CEO
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Name | MR. FOREST E WOODLEY
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Credential |
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Telephone | 206-782-5348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 221
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License Number State | WA
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