Provider Demographics
NPI:1851431282
Name:NORTHWEST FAMILY LIFE LEARNING AND COUNSELING CENTER
Entity Type:Organization
Organization Name:NORTHWEST FAMILY LIFE LEARNING AND COUNSELING CENTER
Other - Org Name:NORTHWEST FAMILY LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HAN-MAE
Authorized Official - Middle Name:ELLA
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-363-9601
Mailing Address - Street 1:12360 LAKE CITY WAY NE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125
Mailing Address - Country:US
Mailing Address - Phone:206-363-9601
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:12360 LAKE CITY WAY NE
Practice Address - Street 2:SUITE 420
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125
Practice Address - Country:US
Practice Address - Phone:206-363-9601
Practice Address - Fax:206-363-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601196797251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA307827OtherVALUEOPTIONS PROVIDER #