MEDICARE: NORTHWEST RESTORATIVE COUNSELING

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477309821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST RESTORATIVE COUNSELING

Provider Business Mailing Address
First Line	:	929 N 76TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4724
Country	:	US
Telephone Number	:	509-906-1499
Fax Number	:

Provider Business Practice Location Address
First Line	:	5631 KIRKWOOD PL N UNIT C
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5929
Country	:	US
Telephone Number	:	509-906-1499
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH COUNSELOR
Name	:	CORNELIA ELISE LAWSON
Credential	:	LMHCA, SUDPT
Telephone Number	:	205-751-5184

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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