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General NPI Number Information
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NPI Number | 1407352362
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Entity Type | Organization
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Legal Business Name | ENGAGING MINDFULNESS FORGING MEANING, PLLC
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Dates
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Enumeration Date | 03/31/2018
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Last Update Date | 03/31/2018
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Provider Practice Location Address
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Address Line | 1500 FAIRVIEW AVE E STE 205
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City | SEATTLE
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State | WA
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Zip | 98102-3727
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Country | US
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Telephone | 206-250-9166
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 STONE WAY N STE A
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City | SEATTLE
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State | WA
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Zip | 98103-8052
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Country | US
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Telephone | 206-250-9166
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Fax |
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Authorized Official
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Title or Position | OWNER, SOLE MEMBER, AGENT
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Name | MR. BRUCE BARTJA WACHTEL
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Credential | LICSW, MHP, CMHS
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Telephone | 206-250-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 603534700
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License Number State | WA
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