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General NPI Number Information
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NPI Number | 1598134595
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Entity Type | Organization
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Legal Business Name | THIS TOO SHALL PASS
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Dates
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Enumeration Date | 09/19/2015
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Last Update Date | 09/19/2015
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Provider Practice Location Address
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Address Line | 9951 MICKELBERRY RD NW STE 137
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City | SILVERDALE
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State | WA
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Zip | 98383-8309
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Country | US
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Telephone | 888-868-6952
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5828
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City | BREMERTON
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State | WA
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Zip | 98312-0596
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Country | US
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Telephone | 360-809-2971
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. CHRISTINE ELLEN PUEBLA
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Credential | LMFT, CMHS
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Telephone | 360-809-2971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF 60300097
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 60107671
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License Number State | WA
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