Provider Demographics
NPI:1356708135
Name:NEW LIFE COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:NEW LIFE COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MELANIE
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHCA,,MHP
Authorized Official - Phone:253-269-0224
Mailing Address - Street 1:514 STATE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4556
Mailing Address - Country:US
Mailing Address - Phone:253-269-0224
Mailing Address - Fax:
Practice Address - Street 1:514 STATE AVE STE 107
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4556
Practice Address - Country:US
Practice Address - Phone:253-269-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001646101YA0400X
101YM0800X
WAMC60502604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2039243Medicaid