=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659181923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TACOMA RECOVERY COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2025
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 346 E MASTHEAD DR STE 101
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49423-8157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-679-8722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 346 E MASTHEAD DR STE 101
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49423-8157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-679-8722
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL/CEO
-----------------------------------------------------
Name | MR. CHRIS A CAUSEY
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 206-679-8722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------