Provider Demographics
NPI:1619643855
Name:DE NOVO COUNSELING
Entity Type:Organization
Organization Name:DE NOVO COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:913-999-9079
Mailing Address - Street 1:15513 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-8709
Mailing Address - Country:US
Mailing Address - Phone:913-999-9079
Mailing Address - Fax:
Practice Address - Street 1:1225 E SUNSET DR STE 145
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3554
Practice Address - Country:US
Practice Address - Phone:913-999-9079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA35001997AOtherLMFT LICENSE