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General NPI Number Information
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NPI Number | 1194592063
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Entity Type | Organization
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Legal Business Name | COURAGEOUS QUEST THERAPY, PLLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 410 W BAKERVIEW RD STE 110
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City | BELLINGHAM
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State | WA
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Zip | 98226-8184
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Country | US
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Telephone | 360-739-3548
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Fax | 360-775-2116
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Provider Business Mailing Address
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Address Line | PO BOX 1782
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City | FERNDALE
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State | WA
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Zip | 98248-1782
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Country | US
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Telephone | 360-739-3548
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Fax | 360-775-2116
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ESCARLETH MILENA DE LEON
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Credential | LMFT
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Telephone | 360-739-3548
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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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