Provider Demographics
NPI:1457622797
Name:MARRIAGE AND FAMILY LIFE LLC
Entity Type:Organization
Organization Name:MARRIAGE AND FAMILY LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:253-302-4345
Mailing Address - Street 1:8509 WOODLAWN AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2922
Mailing Address - Country:US
Mailing Address - Phone:253-302-4345
Mailing Address - Fax:213-285-6558
Practice Address - Street 1:3102 S 23RD ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1606
Practice Address - Country:US
Practice Address - Phone:253-355-6619
Practice Address - Fax:213-285-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60174444101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty