Provider Demographics
NPI:1356878797
Name:ARIEL KOFOED INC
Entity type:Organization
Organization Name:ARIEL KOFOED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:BLANCHE
Authorized Official - Last Name:KOFOED
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:253-564-4450
Mailing Address - Street 1:3318 BRIDGEPORT WAY W STE D3
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4598
Mailing Address - Country:US
Mailing Address - Phone:253-564-4450
Mailing Address - Fax:
Practice Address - Street 1:3318 BRIDGEPORT WAY W STE D3
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4598
Practice Address - Country:US
Practice Address - Phone:253-564-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60535747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty