Basic Information
| Provider Information | |||||||||
| NPI: | 1750821781 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROSPERITY COUNSELING & TREATMENT SERVICES INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROSPERITY WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11012 CANYON RD E | ||||||||
| Address2: | SUITE 8-385 | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983734200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535366425 | ||||||||
| FaxNumber: | 2535366637 | ||||||||
| Practice Location | |||||||||
| Address1: | 12201 PACIFIC AVE S | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984445126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535366425 | ||||||||
| FaxNumber: | 2535366637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2017 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STRATFORD | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REVENUE CYCLE MANAGEMEN | ||||||||
| AuthorizedOfficialTelephone: | 8665860024 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PROSPERITY COUNSELING & TREATMENT SERVICES INC. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 168900 | WA | Y | Agencies | Community/Behavioral Health |
No ID Information.