Provider Demographics
NPI:1033487350
Name:GREENLAKE COUNSELING, INC
Entity Type:Organization
Organization Name:GREENLAKE COUNSELING, INC
Other - Org Name:SEATTLE CHRISTIAN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEU
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:425-736-1676
Mailing Address - Street 1:10830 NE 148TH LN
Mailing Address - Street 2:G101
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-4898
Mailing Address - Country:US
Mailing Address - Phone:425-736-1676
Mailing Address - Fax:
Practice Address - Street 1:444 NE RAVENNA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6467
Practice Address - Country:US
Practice Address - Phone:425-736-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty