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General NPI Number Information
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NPI Number | 1245706795
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Entity Type | Organization
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Legal Business Name | AES PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 631 STRANDER BLVD BLDG A STE G
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City | TUKWILA
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State | WA
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Zip | 98188-2963
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Country | US
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Telephone | 425-946-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 631 STRANDER BLVD BLDG A STE G
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City | TUKWILA
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State | WA
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Zip | 98188-2963
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Country | US
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Telephone | 425-946-4411
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Fax |
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Authorized Official
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Title or Position | LMHC/OWNER
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Name | TIMOTHY STEWART
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Credential |
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Telephone | 425-943-0152
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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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