Provider Demographics
NPI:1184290058
Name:LA PERLA COUNSELING AND TRAUMA RESPONSE SERVICES, INC.
Entity type:Organization
Organization Name:LA PERLA COUNSELING AND TRAUMA RESPONSE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, CSAT-S
Authorized Official - Phone:425-985-2143
Mailing Address - Street 1:1611 116TH AVE NE STE 221
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3063
Mailing Address - Country:US
Mailing Address - Phone:425-449-8171
Mailing Address - Fax:
Practice Address - Street 1:1611 116TH AVE NE STE 221
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3063
Practice Address - Country:US
Practice Address - Phone:425-449-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty