=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497266514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A NEW BEGINNING FAMILY & TRAUMA COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2017
-----------------------------------------------------
Last Update Date | 06/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14705 MERIDIAN E
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-693-1888
-----------------------------------------------------
Fax | 253-446-7458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14705 MERIDIAN E
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98375-6626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-583-6549
-----------------------------------------------------
Fax | 253-446-7458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT EDWARD CERKA
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 206-693-1888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 60628193
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 60628193
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------