Provider Demographics
NPI:1134845480
Name:MADRONA COUNSELING INSTITUTE
Entity type:Organization
Organization Name:MADRONA COUNSELING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, APCC
Authorized Official - Phone:916-413-8544
Mailing Address - Street 1:PO BOX 951
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-0951
Mailing Address - Country:US
Mailing Address - Phone:916-413-8544
Mailing Address - Fax:
Practice Address - Street 1:434 MADRONA ST STE C
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-8573
Practice Address - Country:US
Practice Address - Phone:916-413-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604693208OtherWA BUSINESS LICENSE