Provider Demographics
NPI: | 1437622016 |
---|---|
Name: | STORYLINE COUNSELING & WELLNESS, PLLC |
Entity Type: | Organization |
Organization Name: | STORYLINE COUNSELING & WELLNESS, PLLC |
Other - Org Name: | STORYLINE COUNSELING |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER / COUNSELOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHAWN |
Authorized Official - Middle Name: | PETER |
Authorized Official - Last Name: | HOFING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMHC |
Authorized Official - Phone: | 360-920-1696 |
Mailing Address - Street 1: | 709 FRONT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LYNDEN |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98264-1819 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-685-8114 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 709 FRONT ST |
Practice Address - Street 2: | |
Practice Address - City: | LYNDEN |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98264-1819 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-685-8114 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-01-07 |
Last Update Date: | 2023-11-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |