=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447217013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYHRE COUNSELING SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 08/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 MAPLE AVE SUITE B
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-563-0847
-----------------------------------------------------
Fax | 360-563-0827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 MAPLE AVE SUITE B
-----------------------------------------------------
City | SNOHOMISH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98290-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-563-0847
-----------------------------------------------------
Fax | 360-563-0827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. KATHLEEN MARIE MYHRE
-----------------------------------------------------
Credential | MSW LICSW
-----------------------------------------------------
Telephone | 360-563-0847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LW00004254
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------