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General NPI Number Information
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NPI Number | 1033487350
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Entity Type | Organization
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Legal Business Name | GREENLAKE COUNSELING, INC
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 444 NE RAVENNA BLVD STE 301
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City | SEATTLE
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State | WA
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Zip | 98115-6467
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Country | US
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Telephone | 425-736-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 10830 NE 148TH LN G101
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City | BOTHELL
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State | WA
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Zip | 98011-4898
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Country | US
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Telephone | 425-736-1676
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | MR. BENJAMIN DEU
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Credential | M.A.
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Telephone | 425-736-1676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00010988
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License Number State | WA
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