=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275198426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIFIED COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2019
-----------------------------------------------------
Last Update Date | 05/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26331 NE VALLEY ST
-----------------------------------------------------
City | DUVALL
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98019-5022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-224-6123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 623
-----------------------------------------------------
City | LAKE STEVENS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98258-0623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-549-5533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SPECIALIST
-----------------------------------------------------
Name | KARA KOMARZEC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-549-5533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------