Provider Demographics
NPI:1033863592
Name:LIMINAL TERRESTRIAL
Entity Type:Organization
Organization Name:LIMINAL TERRESTRIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, ATR
Authorized Official - Phone:206-717-4433
Mailing Address - Street 1:2910 E MADISON ST STE 112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4214
Mailing Address - Country:US
Mailing Address - Phone:206-717-4433
Mailing Address - Fax:
Practice Address - Street 1:2910 E MADISON ST STE 112
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4214
Practice Address - Country:US
Practice Address - Phone:206-717-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty