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NPI Code Detail

MEDICARE: STEEP STREET COUNSELING, LLC

MEDICARE: STEEP STREET COUNSELING, LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/CenterLW60271794WA
2261QM0850XAdult Mental Health Clinic/CenterLW60271794WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11215164322OTHERWAINDIVIDUAL NPI

General Provider Information

NPI Number : 1144701293
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEEP STREET COUNSELING, LLC
Provider Business Mailing Address
First Line : 601 E MCLOUGHLIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3358
Country : US
Telephone Number : 360-607-6017
Fax Number :
Provider Business Practice Location Address
First Line : 601 E MCLOUGHLIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3358
Country : US
Telephone Number : 360-607-6017
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. SANDY RUBY SEWELL
Credential : LICSW, CMHS
Telephone Number : 360-607-6017
Provider Enumeration Date : 08/27/2018
Last Update Date : 08/27/2018

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Directions to “STEEP STREET COUNSELING, LLC ” Practice Location

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