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General NPI Number Information
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NPI Number | 1770028813
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Entity Type | Organization
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Legal Business Name | OLIVE TREE THERAPY LLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 3515 SW ALASKA ST
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City | SEATTLE
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State | WA
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Zip | 98126-2730
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Country | US
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Telephone | 425-243-3476
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Fax |
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Provider Business Mailing Address
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Address Line | 3451 24TH AVE W L522
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City | SEATTLE
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State | WA
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Zip | 98199-2200
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Country | US
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Telephone | 253-335-3027
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DANIELLE SCARSELLA-GONIA
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Credential |
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Telephone | 253-335-3027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MG60604590
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License Number State | WA
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