Provider Demographics
NPI:1154151124
Name:WELL HARBOR PLLC
Entity type:Organization
Organization Name:WELL HARBOR PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHLIA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-500-8812
Mailing Address - Street 1:4405 7TH AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1055
Mailing Address - Country:US
Mailing Address - Phone:253-254-5713
Mailing Address - Fax:
Practice Address - Street 1:4405 7TH AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1055
Practice Address - Country:US
Practice Address - Phone:253-254-5713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist