Provider Demographics
NPI:1821365974
Name:ISLAND COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:ISLAND COUNSELING AND CONSULTING
Other - Org Name:LOIS HAYNES COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:MARYANNE
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-544-2245
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-0881
Mailing Address - Country:US
Mailing Address - Phone:360-544-2245
Mailing Address - Fax:360-321-5697
Practice Address - Street 1:765 WONN RD
Practice Address - Street 2:#C202
Practice Address - City:GREENBANK
Practice Address - State:WA
Practice Address - Zip Code:98253-6422
Practice Address - Country:US
Practice Address - Phone:360-544-2245
Practice Address - Fax:360-321-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health