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20102 Cedar Valley Rd Ste 204 Lynnwood WA 98036-6333 | |
| (425) 338-7589 | |
| (425) 771-8400 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 20102 Cedar Valley Rd Ste 204, Lynnwood, Washington |
| Authorized Official Name and Position | Angela D Olson (OWNER) |
| Authorized Official Contact | 4253387589 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
20102 Cedar Valley Rd Ste 204 Lynnwood WA 98036-6333 Ph: (425) 338-7589 | 20102 Cedar Valley Rd Ste 204 Lynnwood WA 98036-6333 Ph: (425) 338-7589 |
| NPI Number | 1932443280 |
|---|---|
| Provider Enumeration Date | 11/26/2012 |
| Last Update Date | 10/02/2024 |
| Certification Date | 10/02/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932443280 | NPI | - | NPPES |
| 1770768889 | Other | WA | NPI TYPE 1 |
| 2005943 | Medicaid | WA | |
| 2045044 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LH00011149 (Washington) | Primary |
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