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General NPI Number Information
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NPI Number | 1366190191
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Entity Type | Organization
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Legal Business Name | INTREPID THERAPY COLLECTIVE PLLC
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 720 SENECA ST STE 107
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City | SEATTLE
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State | WA
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Zip | 98101-3265
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Country | US
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Telephone | 833-338-0038
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Fax |
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Provider Business Mailing Address
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Address Line | 2103 HARRISON AVE NW STE 2-875
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City | OLYMPIA
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State | WA
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Zip | 98502-2636
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN BJORGAARD
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Credential |
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Telephone | 360-230-8011
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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