Provider Demographics
NPI:1295333664
Name:NORTHWEST CHRISTIAN COUNSELING SERVICE, LLC
Entity type:Organization
Organization Name:NORTHWEST CHRISTIAN COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF SCIENCE
Authorized Official - Phone:253-861-2718
Mailing Address - Street 1:2602 S 38TH ST UNIT 18
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7303
Mailing Address - Country:US
Mailing Address - Phone:253-861-2718
Mailing Address - Fax:253-212-2852
Practice Address - Street 1:7406 27TH ST W STE 30
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4637
Practice Address - Country:US
Practice Address - Phone:253-861-2718
Practice Address - Fax:253-212-2852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health