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General NPI Number Information
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NPI Number | 1356744460
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Entity Type | Organization
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Legal Business Name | IBG COUNSELING AND EDUCATIONAL CENTER, INC
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 10202 PACIFIC AVE S STE 208
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City | TACOMA
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State | WA
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Zip | 98444-6573
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Country | US
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Telephone | 253-970-6499
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Fax | 253-581-0927
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Provider Business Mailing Address
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Address Line | 10202 PACIFIC AVE S STE 208
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City | TACOMA
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State | WA
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Zip | 98444-6573
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Country | US
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Telephone | 253-970-6499
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Fax | 253-581-0927
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Authorized Official
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Title or Position | DIRECTOR
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Name | FELITA HANNAH POOLE
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Credential | MA
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Telephone | 253-970-6499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 602485247
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License Number State | WA
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