MEDICARE: CROW CITY COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1134719966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROW CITY COUNSELING PLLC

Provider Business Mailing Address
First Line	:	5306 BALLARD AVE NW STE 326
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4367
Country	:	US
Telephone Number	:	206-261-6255
Fax Number	:

Provider Business Practice Location Address
First Line	:	5306 BALLARD AVE NW STE 326
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4367
Country	:	US
Telephone Number	:	206-261-6255
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, THERAPIST
Name	:	PATRICK DONLEY
Credential	:	LMHCA
Telephone Number	:	206-261-6255

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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