Provider Demographics
NPI:1376673566
Name:COUNSELING CENTERS OF NORTH PUGET SOUND
Entity Type:Organization
Organization Name:COUNSELING CENTERS OF NORTH PUGET SOUND
Other - Org Name:PRESBYTERIAN COUNSELING SERVICE NORTH, A SAMARITAN COUNSELING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-708-9595
Mailing Address - Street 1:1306B LAKE VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1844
Mailing Address - Country:US
Mailing Address - Phone:360-568-8737
Mailing Address - Fax:360-568-1654
Practice Address - Street 1:1306 LAKE VIEW AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1844
Practice Address - Country:US
Practice Address - Phone:360-568-8737
Practice Address - Fax:360-568-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601249571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPR2525OtherBCBS GROUP PIN
WA002915001OtherGROUP HEALTH GROUP NUMBER
WAGAB04999Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WAGAB05000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER