Provider Demographics
NPI:1205156338
Name:CONSEJO COUNSELING AND REFERRAL SERVICES
Entity type:Organization
Organization Name:CONSEJO COUNSELING AND REFERRAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCHMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-461-4880
Mailing Address - Street 1:723 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5223
Mailing Address - Country:US
Mailing Address - Phone:206-461-4880
Mailing Address - Fax:206-461-6989
Practice Address - Street 1:5915 ORCHARD ST W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3824
Practice Address - Country:US
Practice Address - Phone:206-461-4880
Practice Address - Fax:206-461-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA037101Y00000X, 101YA0400X, 104100000X, 261QR0405X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder