MEDICARE: GROWTH & WELLNESS 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
1	261QM0850X	Adult Mental Health Clinic/Center	LW60804492	WA

General Provider Information

NPI Number	:	1710494588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTH & WELLNESS COUNSELING PLLC

Provider Business Mailing Address
First Line	:	1421 34TH AVE STE 205
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-3634
Country	:	US
Telephone Number	:	206-485-3557
Fax Number	:	855-440-1447

Provider Business Practice Location Address
First Line	:	1421 34TH AVE STE 205
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-3634
Country	:	US
Telephone Number	:	206-485-3557
Fax Number	:	855-440-1447

Authorized Official
Title or Position	:	GOVERNER
Name	:	KENNETH KEALA MARSHALL
Credential	:	LICSW
Telephone Number	:	206-485-3557

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	01/04/2021

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