Basic Information
| Provider Information | |||||||||
| NPI: | 1417134172 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHARIS COUNSELING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 RIDGEVIEW DR | ||||||||
| Address2: | |||||||||
| City: | SEDRO WOOLLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982849522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605956011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1427 MONTE VISTA DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982739114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603124093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2008 | ||||||||
| LastUpdateDate: | 01/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | LOZAR | ||||||||
| AuthorizedOfficialFirstName: | BETSY | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED MENTAL HEALTH COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 3603124093 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00011157 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | RC00023108 | 01 | WA | COUNSELOR REGISTERED | OTHER | LH00011157 | 01 | WA | MENTAL HEALTH COUNSELOR | OTHER |