Provider Demographics
NPI:1497266514
Name:A NEW BEGINNING FAMILY & TRAUMA COUNSELING
Entity Type:Organization
Organization Name:A NEW BEGINNING FAMILY & TRAUMA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CERKA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:206-693-1888
Mailing Address - Street 1:14705 MERIDIAN E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6626
Mailing Address - Country:US
Mailing Address - Phone:253-583-6549
Mailing Address - Fax:253-446-7458
Practice Address - Street 1:14705 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375
Practice Address - Country:US
Practice Address - Phone:206-693-1888
Practice Address - Fax:253-446-7458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60628193251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2086195Medicaid