Provider Demographics
NPI:1043982259
Name:BRANDY OTO COUNSELING
Entity Type:Organization
Organization Name:BRANDY OTO COUNSELING
Other - Org Name:THRIVE WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-334-6950
Mailing Address - Street 1:27203 216TH AVE SE STE 5
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-3273
Mailing Address - Country:US
Mailing Address - Phone:425-584-7570
Mailing Address - Fax:
Practice Address - Street 1:27203 216TH AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:425-584-7570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDY OTO COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-05
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder