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General NPI Number Information
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NPI Number | 1740549633
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Entity Type | Organization
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Legal Business Name | INTEGRATED THERAPY SERVICES NW PLLC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 6004 WESTGATE BLVD SUITE 180
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City | TACOMA
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State | WA
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Zip | 98406-2503
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Country | US
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Telephone | 253-460-7248
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Fax | 253-564-4409
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Provider Business Mailing Address
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Address Line | 6004 WESTGATE BLVD SUITE 180
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City | TACOMA
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State | WA
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Zip | 98406-2503
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Country | US
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Telephone | 253-460-7248
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Fax | 253-564-4409
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Authorized Official
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Title or Position | CO-OWNER
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Name | JEANNE PURDUM
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Credential | LMFT
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Telephone | 253-460-7248
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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 | LF00001770
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License Number State | WA
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