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General NPI Number Information
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NPI Number | 1497521694
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Entity Type | Organization
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Legal Business Name | PEACEFUL HEART THERAPY, PLLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 205 S 51ST ST # 9E
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City | RENTON
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State | WA
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Zip | 98055-7942
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Country | US
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Telephone | 425-525-9792
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Fax |
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Provider Business Mailing Address
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Address Line | 205 S 51ST ST # 9E
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City | RENTON
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State | WA
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Zip | 98055-7942
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Country | US
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Telephone | 425-525-9792
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | MS. SEOLAH PARK
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Credential | LMHC
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Telephone | 425-525-9792
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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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