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General NPI Number Information
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NPI Number | 1750747762
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Entity Type | Organization
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Legal Business Name | PEGASUS COUNSELING, LLC
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1812 E MADISON ST STE 107
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City | SEATTLE
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State | WA
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Zip | 98122-2873
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Country | US
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Telephone | 802-356-1478
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 E MADISON ST STE 107
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City | SEATTLE
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State | WA
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Zip | 98122-2873
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Country | US
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Telephone | 802-356-1478
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COURTNEY BOHEN
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Credential | LICSW
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Telephone | 802-356-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0890056470
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License Number State | VT
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