Provider Demographics
NPI:1538663604
Name:THE SHELTERWOOD COLLECTIVE
Entity Type:Organization
Organization Name:THE SHELTERWOOD COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER/CODIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMONTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:206-915-8694
Mailing Address - Street 1:108 S JACKSON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2883
Mailing Address - Country:US
Mailing Address - Phone:206-915-8694
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST STE 203
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2883
Practice Address - Country:US
Practice Address - Phone:206-915-8694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60502246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty