Provider Demographics
NPI:1356906853
Name:BACI COUNSELING, LLC
Entity type:Organization
Organization Name:BACI COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOUKHAM
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BOUNKEUA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-345-2640
Mailing Address - Street 1:3707 SMITHERS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6808
Mailing Address - Country:US
Mailing Address - Phone:206-356-2640
Mailing Address - Fax:425-955-9326
Practice Address - Street 1:3707 SMITHERS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6808
Practice Address - Country:US
Practice Address - Phone:206-356-2640
Practice Address - Fax:425-955-9326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty