Provider Demographics
NPI:1750254629
Name:URBAN REFUGE THERAPY, LLC
Entity type:Organization
Organization Name:URBAN REFUGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MAIRUT
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSWAIC
Authorized Official - Phone:253-389-6353
Mailing Address - Street 1:6308 52ND AVE W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3711
Mailing Address - Country:US
Mailing Address - Phone:253-389-6353
Mailing Address - Fax:
Practice Address - Street 1:2550 YAKIMA AVE UNIT A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3863
Practice Address - Country:US
Practice Address - Phone:253-389-6353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)