MEDICARE: GOOD INTENTION COUNSELING SERVICES, 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
1	251S00000X	Community/Behavioral Health Agency	LW60494715	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1295184133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD INTENTION COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	8400 5TH AVE NE UNIT 8
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-4163
Country	:	US
Telephone Number	:	206-954-3348
Fax Number	:	206-566-6913

Provider Business Practice Location Address
First Line	:	8400 5TH AVE NE UNIT 8
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-4163
Country	:	US
Telephone Number	:	206-954-3348
Fax Number	:	206-566-6913

Authorized Official
Title or Position	:	PRESIDENT/CHIEF CLINICAL ADVISOR
Name	:	MR. PHILLIP MAURICE CARR
Credential	:	LICSW
Telephone Number	:	206-954-3348

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	10/21/2021

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