Provider Demographics
NPI:1619595311
Name:RECENTER SELF
Entity Type:Organization
Organization Name:RECENTER SELF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TIMMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-437-0178
Mailing Address - Street 1:310 3RD AVE NE STE 109
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3346
Mailing Address - Country:US
Mailing Address - Phone:206-437-0178
Mailing Address - Fax:
Practice Address - Street 1:310 3RD AVE NE STE 109
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3346
Practice Address - Country:US
Practice Address - Phone:206-437-0178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty