MEDICARE: SAND AND STONE 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	101YM0800X	Mental Health Counselor	LH60489725	WA

General Provider Information

NPI Number	:	1881142867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAND AND STONE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	418 CARPENTER RD SE
Second Line	:	SUITE 104
City	:	LACEY
State	:	WA
Zip	:	98503-7905
Country	:	US
Telephone Number	:	360-888-3776
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 CARPENTER RD SE
Second Line	:	SUITE 104
City	:	LACEY
State	:	WA
Zip	:	98503-7905
Country	:	US
Telephone Number	:	360-888-3776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RONDALE FELIX
Credential	:	M.S.
Telephone Number	:	360-888-3776

Provider Enumeration Date	:	09/19/2016
Last Update Date	:	09/19/2016

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