Provider Demographics
NPI:1396216974
Name:WELLNESS COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:WELLNESS COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KATREACE
Authorized Official - Middle Name:KATRELL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, SUDP, LMHCA
Authorized Official - Phone:253-244-1410
Mailing Address - Street 1:7406 27TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4632
Mailing Address - Country:US
Mailing Address - Phone:253-244-1410
Mailing Address - Fax:
Practice Address - Street 1:7406 27TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4632
Practice Address - Country:US
Practice Address - Phone:253-244-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2111590Medicaid