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General NPI Number Information
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NPI Number | 1922567759
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Entity Type | Organization
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Legal Business Name | OTTERSON COUNSELING PS
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 720 MAIN ST STE 224
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City | MOUNT VERNON
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State | WA
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Zip | 98273-3830
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Country | US
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Telephone | 360-631-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 19213 SOUNDVIEW DR NW
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City | STANWOOD
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State | WA
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Zip | 98292-7878
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Country | US
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Telephone | 360-631-8050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH ANN OTTERSON
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Credential |
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Telephone | 360-631-0949
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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