Provider Demographics
NPI:1174643183
Name:SERENITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:SERENITY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CDP
Authorized Official - Phone:253-922-0229
Mailing Address - Street 1:5113 PACIFIC HWY E
Mailing Address - Street 2:SUITE3
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2659
Mailing Address - Country:US
Mailing Address - Phone:253-922-0229
Mailing Address - Fax:253-926-4183
Practice Address - Street 1:5113 PACIFIC HWY E
Practice Address - Street 2:SUITE3
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2659
Practice Address - Country:US
Practice Address - Phone:253-922-0229
Practice Address - Fax:253-926-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101YA0400XOtherADICTION SUBSTANCE ABUSE