Provider Demographics
NPI:1407371966
Name:AZUL COUNSELING
Entity Type:Organization
Organization Name:AZUL COUNSELING
Other - Org Name:EDGAR HERNANDEZ, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-245-3756
Mailing Address - Street 1:5425 RAINIVER AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118
Mailing Address - Country:US
Mailing Address - Phone:206-245-3756
Mailing Address - Fax:
Practice Address - Street 1:5425 RAINIER AVE S STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2455
Practice Address - Country:US
Practice Address - Phone:206-309-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000097171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604153055OtherWASHINGTON DOR