Provider Demographics
NPI:1194592063
Name:COURAGEOUS QUEST THERAPY, PLLC
Entity type:Organization
Organization Name:COURAGEOUS QUEST THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ESCARLETH
Authorized Official - Middle Name:MILENA
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:360-739-3548
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-1782
Mailing Address - Country:US
Mailing Address - Phone:360-739-3548
Mailing Address - Fax:360-775-2116
Practice Address - Street 1:410 W BAKERVIEW RD STE 110
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8184
Practice Address - Country:US
Practice Address - Phone:360-739-3548
Practice Address - Fax:360-775-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty