Provider Demographics
NPI:1063023752
Name:NW TRANSFORMATIONS CHILD AND FAMILY COUNSELING PLLC
Entity Type:Organization
Organization Name:NW TRANSFORMATIONS CHILD AND FAMILY COUNSELING PLLC
Other - Org Name:NW TRANSFORMATIONS CHILD AND FAMILY COUNSELING PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-634-9699
Mailing Address - Street 1:1420 MARVIN RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3878
Mailing Address - Country:US
Mailing Address - Phone:360-634-9699
Mailing Address - Fax:360-539-3332
Practice Address - Street 1:6402 57TH CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-4159
Practice Address - Country:US
Practice Address - Phone:360-970-8356
Practice Address - Fax:360-539-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1518347384Medicaid