Provider Demographics
NPI:1063102036
Name:THE WORKSHOP THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:THE WORKSHOP THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCC
Authorized Official - Phone:206-920-7168
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:ID
Mailing Address - Zip Code:83825-0487
Mailing Address - Country:US
Mailing Address - Phone:206-920-7168
Mailing Address - Fax:
Practice Address - Street 1:310 4TH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:ID
Practice Address - Zip Code:83825-0487
Practice Address - Country:US
Practice Address - Phone:206-920-7168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty