MEDICARE: APPROACHING AUTHENTICITY, 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	251S00000X	Community/Behavioral Health Agency	LW60083962	WA

General Provider Information

NPI Number	:	1811326804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPROACHING AUTHENTICITY, PLLC

Provider Business Mailing Address
First Line	:	12812 3RD AVE SE STE A
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6455
Country	:	US
Telephone Number	:	206-375-7657
Fax Number	:	206-319-5325

Provider Business Practice Location Address
First Line	:	12812 3RD AVE SE STE A
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6455
Country	:	US
Telephone Number	:	206-375-7657
Fax Number	:	206-319-5325

Authorized Official
Title or Position	:	PRESIDENT, MEMBER, THERAPIST
Name	:	REGINA A BLACKWOLF
Credential	:	MSW, LICSW
Telephone Number	:	206-375-7657

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	03/03/2023

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