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NPI Code Detail

MEDICARE: BUENA VIDA COUNSELING PLLC

MEDICARE: BUENA VIDA COUNSELING PLLC
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/Center
2261QM0850XAdult Mental Health Clinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265077846
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUENA VIDA COUNSELING PLLC
Provider Business Mailing Address
First Line : PO BOX 541
Second Line :
City : SHELTON
State : WA
Zip : 98584-0541
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2146 W RAILROAD AVE STE A
Second Line :
City : SHELTON
State : WA
Zip : 98584-7126
Country : US
Telephone Number : 360-358-2085
Fax Number : 360-485-4964
Authorized Official
Title or Position : OWNER/MANAGING MEMBER
Name : CHRISTINA MARIE WELLMAN
Credential : LMHC
Telephone Number : 360-358-2085
Provider Enumeration Date : 11/07/2019
Last Update Date : 07/12/2024

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Directions to “BUENA VIDA COUNSELING PLLC ” Practice Location

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