Provider Demographics
NPI:1407881956
Name:CENTER FOR TRANSPERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:CENTER FOR TRANSPERSONAL DEVELOPMENT
Other - Org Name:FULL CIRCLE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-376-6181
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0363
Mailing Address - Country:US
Mailing Address - Phone:360-376-6181
Mailing Address - Fax:360-376-6182
Practice Address - Street 1:1286 MOUNT BAKER RD
Practice Address - Street 2:SUITE B208
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8931
Practice Address - Country:US
Practice Address - Phone:360-376-6181
Practice Address - Fax:360-376-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty