Provider Demographics
NPI:1740500438
Name:NEUROFEEDBACK AND COUNSELING PLLC
Entity type:Organization
Organization Name:NEUROFEEDBACK AND COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:425-610-9241
Mailing Address - Street 1:17921 BOTHELL EVERETT HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-0013
Mailing Address - Country:US
Mailing Address - Phone:524-620-9241
Mailing Address - Fax:258-064-6004
Practice Address - Street 1:17921 BOTHELL EVERETT HWY STE 101
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-0013
Practice Address - Country:US
Practice Address - Phone:524-610-9241
Practice Address - Fax:425-806-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3955-P1041C0700X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty