Provider Demographics
NPI:1932635414
Name:COMMON GROUND COUNSELING LTD.
Entity Type:Organization
Organization Name:COMMON GROUND COUNSELING LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:360-920-8121
Mailing Address - Street 1:1116 KEY ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5232
Mailing Address - Country:US
Mailing Address - Phone:360-920-8121
Mailing Address - Fax:
Practice Address - Street 1:1116 KEY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5232
Practice Address - Country:US
Practice Address - Phone:360-920-8121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60453276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038668Medicaid