Provider Demographics
NPI:1376217521
Name:ENTELECHY PSYCHOTHERAPY
Entity Type:Organization
Organization Name:ENTELECHY PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-954-0039
Mailing Address - Street 1:904 WOODLAND WAY
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6319
Mailing Address - Country:US
Mailing Address - Phone:253-632-2431
Mailing Address - Fax:
Practice Address - Street 1:904 WOODLAND WAY
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6319
Practice Address - Country:US
Practice Address - Phone:253-632-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty