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General NPI Number Information
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NPI Number | 1053620153
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Entity Type | Organization
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Legal Business Name | FAMILY FOCUS
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 9657 FIRDALE AVENUE
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City | EDMONDS
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State | WA
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Zip | 98020-6519
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Country | US
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Telephone | 206-629-4065
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Fax | 360-698-9296
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Provider Business Mailing Address
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Address Line | PO BOX 2784
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City | SILVERDALE
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State | WA
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Zip | 98383-2784
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Country | US
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Telephone | 206-629-4065
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Fax | 360-698-9296
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | SHANNON T CROCKETT
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Credential | LMFT
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Telephone | 425-771-6600
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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 |
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License Number State |
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