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15 S Grady Way Ste 500 Renton WA 98057-3217 | |
| (425) 444-5902 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 15 S Grady Way Ste 500, Renton, Washington |
| Authorized Official Name and Position | Vera P Dragonchuk (OWNER) |
| Authorized Official Contact | 4254445902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
15 S Grady Way Ste 500 Renton WA 98057-3217 Ph: (425) 444-5902 | 15 S Grady Way Ste 500 Renton WA 98057-3217 Ph: (425) 444-5902 |
| NPI Number | 1144735911 |
|---|---|
| Provider Enumeration Date | 12/02/2017 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/24/2024 |
| Medicare PECOS PAC ID | 6901340298 |
|---|---|
| Medicare Enrollment ID | O20240627001703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144735911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LH00011247 (Washington) | Primary |
| Provider Name | Vera Dragonchuk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386779676 PECOS PAC ID: 7719421007 Enrollment ID: I20240627001755 |
| Provider Name | Kathleen Ann Yackey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588278824 PECOS PAC ID: 7810433935 Enrollment ID: I20240725002066 |
| Provider Name | Peggy A Wuest |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689899957 PECOS PAC ID: 4385181577 Enrollment ID: I20240806001675 |
| Provider Name | Cindra Ann Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376032730 PECOS PAC ID: 7911448378 Enrollment ID: I20240925002321 |
| Provider Name | Jerrold Jackson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598021081 PECOS PAC ID: 6002349479 Enrollment ID: I20241024002090 |
| Provider Name | Alexis Livier Moran |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1518477025 PECOS PAC ID: 9133652217 Enrollment ID: I20241028003163 |
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