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General NPI Number Information
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NPI Number | 1811304025
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Entity Type | Organization
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Legal Business Name | SOUND FAMILY CENTER, LLC
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 17924 140TH AVE NE STE#230
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City | WOODINVILLE
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State | WA
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Zip | 98072-4315
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Country | US
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Telephone | 206-419-9168
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Fax | 206-555-5555
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Provider Business Mailing Address
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Address Line | 17924 140TH AVE NE STE #230
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City | WOODINVILLE
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State | WA
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Zip | 98072
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Country | UM
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Telephone | 206-419-9168
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Fax | 206-555-5555
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Authorized Official
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Title or Position | OWNER
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Name | KAELI A CLARK
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Credential | CDP
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Telephone | 206-419-9168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 60295090
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License Number State | WA
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