Provider Demographics
NPI:1043653066
Name:MT. CONSTANCE COUNSELING INC.
Entity Type:Organization
Organization Name:MT. CONSTANCE COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-698-1321
Mailing Address - Street 1:9226 BAYSHORE DR NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9196
Mailing Address - Country:US
Mailing Address - Phone:360-698-1321
Mailing Address - Fax:360-308-0447
Practice Address - Street 1:9226 BAYSHORE DR NW
Practice Address - Street 2:SUITE 150
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9196
Practice Address - Country:US
Practice Address - Phone:360-698-1321
Practice Address - Fax:360-308-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty