Provider Demographics
NPI:1003206020
Name:ELLISON COACHING & COUNSELING GROUP
Entity Type:Organization
Organization Name:ELLISON COACHING & COUNSELING GROUP
Other - Org Name:LIFE COURSE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADAIR
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HASTY-VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-816-2706
Mailing Address - Street 1:PO BOX 59284
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2284
Mailing Address - Country:US
Mailing Address - Phone:206-816-2706
Mailing Address - Fax:253-236-4107
Practice Address - Street 1:24437 RUSSELL RD STE 230
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4950
Practice Address - Country:US
Practice Address - Phone:206-816-2706
Practice Address - Fax:253-236-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603 152 746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty