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General NPI Number Information
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NPI Number | 1992699359
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST PSYCHOTHERAPY
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 381 WALLACE WAY NE # 101
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-2868
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Country | US
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Telephone | 206-999-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 8469 FERNCLIFF AVE NE
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-2937
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARA APPLEBAUM
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Credential | PHD, LMHC
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Telephone | 206-999-3266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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