=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699368217
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING AND EMPOWERING LIFE COACHING AND PSYCHOLOGICAL SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2021
-----------------------------------------------------
Last Update Date | 05/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8407 234TH AVE E
-----------------------------------------------------
City | BUCKLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98321-9432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-257-5177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 211
-----------------------------------------------------
City | LITCHFIELD PARK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85340-0211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-806-3735
-----------------------------------------------------
Fax | 315-546-2406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WENDY PETHYBRIDGE
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 315-806-3735
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------