Provider Demographics
NPI:1467029512
Name:EMILY TABOR COUNSELING, PLLC
Entity Type:Organization
Organization Name:EMILY TABOR COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW, BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-403-8527
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-1247
Mailing Address - Country:US
Mailing Address - Phone:206-403-8527
Mailing Address - Fax:
Practice Address - Street 1:160 NW GILMAN BLVD STE 443
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2550
Practice Address - Country:US
Practice Address - Phone:206-403-8527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)