Provider Demographics
NPI:1477015097
Name:JOSH AND LAUREL WEED LLC
Entity Type:Organization
Organization Name:JOSH AND LAUREL WEED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEED
Authorized Official - Suffix:
Authorized Official - Credentials:LMFTA
Authorized Official - Phone:253-569-7572
Mailing Address - Street 1:25430 157TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4173
Mailing Address - Country:US
Mailing Address - Phone:253-569-7572
Mailing Address - Fax:
Practice Address - Street 1:25430 157TH AVE SE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4173
Practice Address - Country:US
Practice Address - Phone:253-569-7572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSH AND LAUREL WEED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty