1093986564 NPI number — LAMENGE COUNSELING SERVICES, INC.

Table of content: (NPI 1093986564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093986564 NPI number — LAMENGE COUNSELING SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAMENGE COUNSELING SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTERN WASHINGTON COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093986564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 112TH STREET S.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-536-5549
Provider Business Mailing Address Fax Number:
253-536-1255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 112TH STREET S.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-536-5549
Provider Business Practice Location Address Fax Number:
253-536-1255
Provider Enumeration Date:
03/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MENG
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
253-536-5549

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  CP60061821 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251B00000X , with the licence number: CP00001279 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CAQH12657245 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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