Provider Demographics
NPI:1255724845
Name:FAMILY THERAPY AND RECOVERY
Entity type:Organization
Organization Name:FAMILY THERAPY AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNZIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:206-355-0648
Mailing Address - Street 1:15 S GRADY WAY
Mailing Address - Street 2:SUITE 249
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3220
Mailing Address - Country:US
Mailing Address - Phone:206-355-0648
Mailing Address - Fax:
Practice Address - Street 1:15 S GRADY WAY
Practice Address - Street 2:SUITE 249
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3220
Practice Address - Country:US
Practice Address - Phone:206-355-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17165700251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040455Medicaid