Basic Information
| Provider Information | |||||||||
| NPI: | 1962081398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONSEJO CONSELING AND REFERRAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 SW 10TH ST | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980575223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064614880 | ||||||||
| FaxNumber: | 2064616989 | ||||||||
| Practice Location | |||||||||
| Address1: | 62 HENRY RD | ||||||||
| Address2: | |||||||||
| City: | EASTSOUND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982459629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064614880 | ||||||||
| FaxNumber: | 2064616989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2021 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOSCHMA | ||||||||
| AuthorizedOfficialFirstName: | SHANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | IS DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2064614880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.