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NPI Code Detail

MEDICARE: OLIVE TREE THERAPY LLC

MEDICARE: OLIVE TREE THERAPY LLC
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
1106H00000XMarriage & Family TherapistMG60604590WA

General Provider Information

NPI Number : 1770028813
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLIVE TREE THERAPY LLC
Provider Business Mailing Address
First Line : 3451 24TH AVE W
Second Line : L522
City : SEATTLE
State : WA
Zip : 98199-2200
Country : US
Telephone Number : 253-335-3027
Fax Number :
Provider Business Practice Location Address
First Line : 3515 SW ALASKA ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-2730
Country : US
Telephone Number : 425-243-3476
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : DANIELLE SCARSELLA-GONIA
Credential :
Telephone Number : 253-335-3027
Provider Enumeration Date : 12/28/2016
Last Update Date : 12/28/2016

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Directions to “OLIVE TREE THERAPY LLC ” Practice Location

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