Provider Demographics
NPI:1659141786
Name:FIRESIDE PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:FIRESIDE PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BORNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-596-1435
Mailing Address - Street 1:1818 W FRANCIS AVE # 299
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6834
Mailing Address - Country:US
Mailing Address - Phone:509-596-1435
Mailing Address - Fax:
Practice Address - Street 1:201 WESTMINSTER HALL
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99251
Practice Address - Country:US
Practice Address - Phone:509-596-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty