Provider Demographics
NPI:1003261991
Name:WHIDBEY ISLAND THERAPY CENTER
Entity Type:Organization
Organization Name:WHIDBEY ISLAND THERAPY CENTER
Other - Org Name:WITC
Other - Org Type:Other Name
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUCK STROM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, ATR
Authorized Official - Phone:310-722-7063
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-1579
Mailing Address - Country:US
Mailing Address - Phone:360-969-9722
Mailing Address - Fax:
Practice Address - Street 1:5548 MYRTLE AVE
Practice Address - Street 2:STE 101
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-8776
Practice Address - Country:US
Practice Address - Phone:360-969-9722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60474081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty