Provider Demographics
NPI:1568211217
Name:HUMANISTIC THERAPY NW
Entity type:Organization
Organization Name:HUMANISTIC THERAPY NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KIILSGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LICSW, ACSW
Authorized Official - Phone:253-370-8980
Mailing Address - Street 1:9240 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-6140
Mailing Address - Country:US
Mailing Address - Phone:253-370-8980
Mailing Address - Fax:503-966-0849
Practice Address - Street 1:9240 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-6140
Practice Address - Country:US
Practice Address - Phone:253-370-8980
Practice Address - Fax:503-966-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty