Provider Demographics
NPI:1780155416
Name:EASTSIDE WOMEN'S COUNSELING
Entity type:Organization
Organization Name:EASTSIDE WOMEN'S COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-350-0245
Mailing Address - Street 1:2425 84TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2223
Mailing Address - Country:US
Mailing Address - Phone:425-350-0245
Mailing Address - Fax:
Practice Address - Street 1:1621 114TH AVE SE STE 224
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6905
Practice Address - Country:US
Practice Address - Phone:206-507-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518388230OtherNPPES
WAMC60312903OtherWA DEPT OF HEALTH