1033955018 NPI number — BLUE STAR COUNSELING, PLLC

Table of content: (NPI 1033955018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033955018 NPI number — BLUE STAR COUNSELING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE STAR COUNSELING, PLLC
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:
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:
1033955018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 OSPREY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHENEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99004-5222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-953-0358
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N HOWARD ST STE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-0508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-999-2024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
DUANE
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
562-999-2024

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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