Provider Demographics
NPI:1407352362
Name:ENGAGING MINDFULNESS FORGING MEANING, PLLC
Entity Type:Organization
Organization Name:ENGAGING MINDFULNESS FORGING MEANING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE MEMBER, AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:BARTJA
Authorized Official - Last Name:WACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, MHP, CMHS
Authorized Official - Phone:206-250-9166
Mailing Address - Street 1:4111 STONE WAY N STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8052
Mailing Address - Country:US
Mailing Address - Phone:206-250-9166
Mailing Address - Fax:
Practice Address - Street 1:1500 FAIRVIEW AVE E STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3727
Practice Address - Country:US
Practice Address - Phone:206-250-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-31
Last Update Date:2018-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603534700261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891890927OtherSOLE PROVIDER NPI
WALW00008447OtherWASHINGTON STATE DEPARTMENT OF HEALTH SOCIAL WORKER LICENSE NUMBER