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General NPI Number Information
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NPI Number | 1104397033
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Entity Type | Organization
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Legal Business Name | KITSAP FAMILY WELLNESS LLC
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 3587 NW ANDERSON HILL RD
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City | SILVERDALE
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State | WA
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Zip | 98383-9130
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Country | US
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Telephone | 360-434-7097
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Fax | 360-698-5967
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Provider Business Mailing Address
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Address Line | 3587 NW ANDERSON HILL RD
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City | SILVERDALE
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State | WA
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Zip | 98383-9130
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Country | US
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Telephone | 360-434-7097
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Fax | 360-698-5967
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SANDRA QUINN
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Credential |
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Telephone | 360-434-7097
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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 |
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License Number State |
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