Provider Demographics
NPI:1164167953
Name:TREE OF LIFE THERAPY
Entity Type:Organization
Organization Name:TREE OF LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HROMADKA
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:216-282-4749
Mailing Address - Street 1:1121 HARRISON AVE # 1022
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1852
Mailing Address - Country:US
Mailing Address - Phone:216-282-4749
Mailing Address - Fax:
Practice Address - Street 1:14205 SE 36TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1553
Practice Address - Country:US
Practice Address - Phone:216-282-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty