Provider Demographics
NPI:1215232764
Name:KOFOED, ARIEL BLANCHE (MA, LMFT, MHP)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:BLANCHE
Last Name:KOFOED
Suffix:
Gender:F
Credentials:MA, LMFT, MHP
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:BLANCHE
Other - Last Name:VANMECHELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:6824 19TH ST W # 281
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5528
Mailing Address - Country:US
Mailing Address - Phone:253-564-4450
Mailing Address - Fax:253-444-0543
Practice Address - Street 1:3318 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE D3
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466
Practice Address - Country:US
Practice Address - Phone:253-564-4450
Practice Address - Fax:253-444-0543
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60288349106H00000X
WALF60535747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist