Provider Demographics
NPI:1497372460
Name:NORTHWEST THERAPY GROUP PLLC
Entity Type:Organization
Organization Name:NORTHWEST THERAPY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DIONE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-402-1962
Mailing Address - Street 1:8284 28TH CT NE STE A
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-7161
Mailing Address - Country:US
Mailing Address - Phone:360-915-3221
Mailing Address - Fax:360-890-4099
Practice Address - Street 1:8284 28TH CT NE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-7161
Practice Address - Country:US
Practice Address - Phone:360-915-3221
Practice Address - Fax:360-890-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty