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General NPI Number Information
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NPI Number | 1518834308
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Entity Type | Organization
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Legal Business Name | DEEP LAKE COUNSELING
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 561 E PASSAGE VIEW RD
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City | SHELTON
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State | WA
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Zip | 98584-4701
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Country | US
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Telephone | 206-930-5901
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Fax |
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Provider Business Mailing Address
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Address Line | 1546 NE 94TH ST
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City | SEATTLE
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State | WA
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Zip | 98115-3148
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Country | US
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Telephone | 206-930-5901
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN MOORE
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Credential | MAC, MED, MPA, LMHC
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Telephone | 206-930-5901
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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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