Provider Demographics
NPI:1225403454
Name:REFRESH THERAPY, INC
Entity Type:Organization
Organization Name:REFRESH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:360-907-7069
Mailing Address - Street 1:1319 NE 134TH ST # 111
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2717
Mailing Address - Country:US
Mailing Address - Phone:360-907-7069
Mailing Address - Fax:360-326-7224
Practice Address - Street 1:1319 NE 134TH ST # 111
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2717
Practice Address - Country:US
Practice Address - Phone:360-907-7069
Practice Address - Fax:360-326-7224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60139869106H00000X
WALF00002654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty