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General NPI Number Information
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NPI Number | 1174390496
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Entity Type | Organization
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Legal Business Name | GINKGO TREE THERAPY
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 4808 97TH AVE W UNIT B
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City | TACOMA
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State | WA
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Zip | 98467-1402
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Country | US
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Telephone | 360-620-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 748 MARKET ST # 107
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City | TACOMA
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State | WA
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Zip | 98402-3737
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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
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Name | MARGARET MONTGOMERY
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Credential | MA, LMFT, CST
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Telephone | 360-620-0935
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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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Taxonomy #2
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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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