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General NPI Number Information
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NPI Number | 1417532243
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Entity Type | Organization
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Legal Business Name | PNW SEX THERAPY COLLECTIVE
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 1200 WESTLAKE AVE N STE 407
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City | SEATTLE
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State | WA
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Zip | 98109-3528
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Country | US
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Telephone | 206-705-3059
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 WESTLAKE AVE N STE 407
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City | SEATTLE
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State | WA
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Zip | 98109-3528
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Country | US
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Telephone | 206-705-3059
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MIA FINE
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Credential | MS, LMFT, CST
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Telephone | 561-862-7090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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