Provider Demographics
NPI:1295184133
Name:GOOD INTENTION COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:GOOD INTENTION COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF CLINICAL ADVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-954-3348
Mailing Address - Street 1:8400 5TH AVE NE UNIT 8
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4163
Mailing Address - Country:US
Mailing Address - Phone:206-954-3348
Mailing Address - Fax:206-566-6913
Practice Address - Street 1:8400 5TH AVE NE UNIT 8
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4163
Practice Address - Country:US
Practice Address - Phone:206-954-3348
Practice Address - Fax:206-566-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60494715251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114217Medicaid