Basic Information
| Provider Information | |||||||||
| NPI: | 1659453272 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH HILL FAMILY COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12515 MERIDIAN E STE 101 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983733436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538482805 | ||||||||
| FaxNumber: | 2534355980 | ||||||||
| Practice Location | |||||||||
| Address1: | 12515 MERIDIAN E STE 101 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983733436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538482805 | ||||||||
| FaxNumber: | 2534355980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | VAN AKEN | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | LEA | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER, MENTAL HEALTH THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2538482805 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.