Provider Demographics
NPI:1437691599
Name:EASTSIDE THERAPY AND CONSULTATION
Entity Type:Organization
Organization Name:EASTSIDE THERAPY AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MEANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENBOER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:425-577-3828
Mailing Address - Street 1:7901 168TH AVE NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7901 168TH AVE NE
Practice Address - Street 2:SUITE 101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4468
Practice Address - Country:US
Practice Address - Phone:425-577-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty