MEDICARE: COUNSELING CENTERS OF NORTH PUGET SOUND

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	101YP2500X	Professional Counselor	601249571	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PR2525	OTHER	WA	BCBS GROUP PIN
2	002915001	OTHER	WA	GROUP HEALTH GROUP NUMBER

General Provider Information

NPI Number	:	1376673566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CENTERS OF NORTH PUGET SOUND

Provider Business Mailing Address
First Line	:	1306B LAKE VIEW AVE
Second Line	:
City	:	SNOHOMISH
State	:	WA
Zip	:	98290-1844
Country	:	US
Telephone Number	:	360-568-8737
Fax Number	:	360-568-1654

Provider Business Practice Location Address
First Line	:	1306 LAKE VIEW AVE
Second Line	:
City	:	SNOHOMISH
State	:	WA
Zip	:	98290-1844
Country	:	US
Telephone Number	:	360-568-8737
Fax Number	:	360-568-1654

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DOUGLAS P CHANDLER
Credential	:	L.I.C.S.W
Telephone Number	:	360-708-9595

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	02/28/2024

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