MEDICARE: ESSENTIAL MENTAL HEALTH L.L.C.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568125466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL MENTAL HEALTH L.L.C.

Provider Business Mailing Address
First Line	:	3608 70TH AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8405
Country	:	US
Telephone Number	:	360-580-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	3608 70TH AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8405
Country	:	US
Telephone Number	:	360-580-6987
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHELLE FUTCH
Credential	:	LICSW
Telephone Number	:	360-580-6987

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/18/2021

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