Basic Information
| Provider Information | |||||||||
| NPI: | 1225282627 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SERENITY COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5013 PACIFIC HWY E STE 13 | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984243421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539226522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5013 PACIFIC HWY E STE 13 | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984243421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539226522 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2008 | ||||||||
| LastUpdateDate: | 11/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | MYRICK | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2539226522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSW, CDP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00005499 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.