Provider Demographics
NPI:1922567759
Name:OTTERSON COUNSELING PS
Entity Type:Organization
Organization Name:OTTERSON COUNSELING PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OTTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-631-0949
Mailing Address - Street 1:19213 SOUNDVIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7878
Mailing Address - Country:US
Mailing Address - Phone:360-631-8050
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST STE 224
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3830
Practice Address - Country:US
Practice Address - Phone:360-631-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1881872240OtherNPPES