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General NPI Number Information
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NPI Number | 1043779614
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Entity Type | Organization
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Legal Business Name | SEEDS OF GROWTH
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4113 BRIDGEPORT WAY W STE C1
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4325
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Country | US
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Telephone | 253-215-2740
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Fax |
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Provider Business Mailing Address
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Address Line | 4404 PACIFIC ST SW
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City | LAKEWOOD
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State | WA
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Zip | 98499-4244
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Country | US
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Telephone | 253-973-5348
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHARLES CLARK
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Credential | LMHC
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Telephone | 253-215-2740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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