Provider Demographics
NPI:1992155881
Name:PACE, THOMAS JR (CERTIFIED COUNSELOR)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PACE
Suffix:JR
Gender:M
Credentials:CERTIFIED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 BRIDGE WAY N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7951
Mailing Address - Country:US
Mailing Address - Phone:206-632-2236
Mailing Address - Fax:206-632-4467
Practice Address - Street 1:3876 BRIDGE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7951
Practice Address - Country:US
Practice Address - Phone:206-632-2236
Practice Address - Fax:206-632-4467
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60155094101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor