1306816814 NPI number — FAMILY MARRIAGE AND ASSESSMENT COUNSELING, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306816814 NPI number — FAMILY MARRIAGE AND ASSESSMENT COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY MARRIAGE AND ASSESSMENT COUNSELING, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1306816814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24603
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98093-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-589-1611
Provider Business Mailing Address Fax Number:
253-589-1544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7424 BRIDGEPORT WAY W
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-8120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-589-1611
Provider Business Practice Location Address Fax Number:
253-589-1544
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FINWALL
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
STOOKEY
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
253-589-1611

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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