Provider Demographics
NPI:1770007387
Name:MORINA COUNSELING, PC
Entity type:Organization
Organization Name:MORINA COUNSELING, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MORINA
Authorized Official - Suffix:
Authorized Official - Credentials:MS , LMFT
Authorized Official - Phone:360-623-3126
Mailing Address - Street 1:718 4TH AVE N APT 44
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4236
Mailing Address - Country:US
Mailing Address - Phone:360-623-3126
Mailing Address - Fax:
Practice Address - Street 1:9415 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2843
Practice Address - Country:US
Practice Address - Phone:360-623-3126
Practice Address - Fax:360-623-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60483234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114314085OtherPROVIDER NPI