Provider Demographics
NPI:1316180698
Name:ROANOKE PARK COUNSELING
Entity Type:Organization
Organization Name:ROANOKE PARK COUNSELING
Other - Org Name:SHEPHERD'S COUNSELING SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-323-7131
Mailing Address - Street 1:2601 BROADWAY E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3906
Mailing Address - Country:US
Mailing Address - Phone:206-323-7131
Mailing Address - Fax:206-322-4078
Practice Address - Street 1:2601 BROADWAY E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3906
Practice Address - Country:US
Practice Address - Phone:206-323-7131
Practice Address - Fax:206-322-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty