Provider Demographics
NPI:1184250904
Name:THREE TREES COUNSELING
Entity type:Organization
Organization Name:THREE TREES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:FANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-652-6775
Mailing Address - Street 1:8243 SE 322ND PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8806
Mailing Address - Country:US
Mailing Address - Phone:425-652-6775
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST AVE STE 303
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4014
Practice Address - Country:US
Practice Address - Phone:425-652-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1144525916Medicaid