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General NPI Number Information
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NPI Number | 1861159378
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Entity Type | Organization
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Legal Business Name | BLUE PETAL THERAPY LLC
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 2123 113TH DR SE UNIT A
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City | LAKE STEVENS
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State | WA
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Zip | 98258-5107
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Country | US
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Telephone | 720-663-1316
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 113TH DR SE UNIT A
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City | LAKE STEVENS
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State | WA
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Zip | 98258-5107
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Country | US
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Telephone | 720-663-1316
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ARA CHRISTENSEN
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Credential | LMFT
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Telephone | 720-663-1316
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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 |
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License Number State |
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