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General NPI Number Information
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NPI Number | 1205156338
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Entity Type | Organization
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Legal Business Name | CONSEJO COUNSELING AND REFERRAL SERVICES
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 5915 ORCHARD ST W
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City | TACOMA
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State | WA
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Zip | 98467-3824
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Country | US
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Telephone | 206-461-4880
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Fax | 206-461-6989
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Provider Business Mailing Address
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Address Line | 723 SW 10TH ST
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City | RENTON
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State | WA
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Zip | 98057-5223
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Country | US
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Telephone | 206-461-4880
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Fax | 206-461-6989
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Authorized Official
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Title or Position | IS DIRECTOR
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Name | SHANA BOSCHMA
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Credential |
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Telephone | 206-461-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 037
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 037
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 037
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 037
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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