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General NPI Number Information
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NPI Number | 1114496544
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE THERAPY
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 1115 TACOMA AVE S
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City | TACOMA
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State | WA
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Zip | 98402
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Country | US
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Telephone | 253-254-6786
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 TACOMA AVE S
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City | TACOMA
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State | WA
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Zip | 98402-2005
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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 | OWNER/THERAPIST
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Name | ARDIS VANMEERTEN
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Credential | LMHC
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Telephone | 253-254-6786
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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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