Provider Demographics
NPI:1235329251
Name:BOLESKY INTENTION INC
Entity Type:Organization
Organization Name:BOLESKY INTENTION INC
Other - Org Name:SOMA INSTITUTE OF NEUROMUSCULAR INTEGRATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT CORP
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOLESKY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC LMP
Authorized Official - Phone:360-829-1025
Mailing Address - Street 1:730 GRAVITY WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-9587
Mailing Address - Country:US
Mailing Address - Phone:360-829-1025
Mailing Address - Fax:360-829-2805
Practice Address - Street 1:730 GRAVITY WAY
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-9587
Practice Address - Country:US
Practice Address - Phone:360-829-1025
Practice Address - Fax:360-829-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004290101YM0800X
WAMA00004219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty