Provider Demographics
NPI:1538581632
Name:GRACE LIBERTY COUNSELING, PLLC
Entity type:Organization
Organization Name:GRACE LIBERTY COUNSELING, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, LICENSED MENTAL HEALTH C
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CASTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:425-702-8400
Mailing Address - Street 1:P.O. BOX 5029
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009
Mailing Address - Country:US
Mailing Address - Phone:425-702-8400
Mailing Address - Fax:
Practice Address - Street 1:12356 NORTHUP WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-702-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60408050101YM0800X
WALH60707131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty