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General NPI Number Information
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NPI Number | 1629353628
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Entity Type | Organization
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Legal Business Name | ISLAND CENTER FOR COMPLEMENTARY MEDICINE INC PS
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Dates
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Enumeration Date | 10/21/2011
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 2366 EASTLAKE AVE E SUITE 431
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City | SEATTLE
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State | WA
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Zip | 98102-3366
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Country | US
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Telephone | 206-525-0750
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Fax | 206-524-6530
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Provider Business Mailing Address
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Address Line | 6826 28TH AVE NE
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City | SEATTLE
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State | WA
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Zip | 98115-7145
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Country | US
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Telephone | 206-525-0750
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Fax | 206-524-6530
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEBORAH ROSE HOUSEWORTH
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Credential | L.AC.
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Telephone | 206-525-0750
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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 | LH00003885
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC00000208
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License Number State | WA
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