Provider Demographics
NPI:1710494588
Name:GROWTH & WELLNESS COUNSELING PLLC
Entity Type:Organization
Organization Name:GROWTH & WELLNESS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KEALA
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-485-3557
Mailing Address - Street 1:1421 34TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3634
Mailing Address - Country:US
Mailing Address - Phone:206-485-3557
Mailing Address - Fax:855-440-1447
Practice Address - Street 1:1421 34TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3634
Practice Address - Country:US
Practice Address - Phone:206-485-3557
Practice Address - Fax:855-440-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60804492261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health