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General NPI Number Information
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NPI Number | 1053702712
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Entity Type | Organization
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Legal Business Name | BLUE HARBOR COUNSELING, INC.
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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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 | 206-359-0714
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Fax |
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Provider Business Mailing 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 |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW PAUL TIEMEYER
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Credential |
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Telephone | 425-275-2198
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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 | LW60398263
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License Number State | WA
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