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General NPI Number Information
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NPI Number | 1356048052
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Entity Type | Organization
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Legal Business Name | WEST COAST ANXIETY PLLC
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 2331 42ND AVE SW APT 403
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City | SEATTLE
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State | WA
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Zip | 98116-2557
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Country | US
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Telephone | 206-590-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 42ND AVE SW APT 403
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City | SEATTLE
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State | WA
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Zip | 98116-2557
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Country | US
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Telephone | 206-590-2226
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Fax |
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Authorized Official
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Title or Position | FOUNDER, CEO, PSYCHOTHERAPIST
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Name | JENNIFER ELAINE-KETCHAM CROOKS
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Credential | LICSW
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Telephone | 206-590-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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