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General NPI Number Information
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NPI Number | 1780155416
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Entity Type | Organization
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Legal Business Name | EASTSIDE WOMEN'S COUNSELING
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 1621 114TH AVE SE STE 224
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City | BELLEVUE
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State | WA
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Zip | 98004-6905
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Country | US
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Telephone | 206-507-0289
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Fax |
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Provider Business Mailing Address
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Address Line | 2425 84TH AVE SE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-2223
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Country | US
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Telephone | 425-350-0245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLA MUNGER
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Credential | LMHC
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Telephone | 425-350-0245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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