Provider Demographics
NPI:1710654918
Name:REDWOOD PSYCHOLOGICAL & COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:REDWOOD PSYCHOLOGICAL & COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOLYNN-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-343-3289
Mailing Address - Street 1:26311 NE VALLEY ST # 219
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8435
Mailing Address - Country:US
Mailing Address - Phone:425-343-3289
Mailing Address - Fax:
Practice Address - Street 1:26311 NE VALLEY ST # 219
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8435
Practice Address - Country:US
Practice Address - Phone:425-343-3289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty