Provider Demographics
NPI:1851857916
Name:KOMO KULSHAN COUNSELING PLLC
Entity Type:Organization
Organization Name:KOMO KULSHAN COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCILLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-224-2631
Mailing Address - Street 1:7762 CASCADES DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98266-7713
Mailing Address - Country:US
Mailing Address - Phone:360-920-4770
Mailing Address - Fax:360-246-1072
Practice Address - Street 1:1155 N STATE ST STE 608
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5024
Practice Address - Country:US
Practice Address - Phone:360-246-1072
Practice Address - Fax:360-246-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty