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Provider Information for 1437547007


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A NEW BEGINNING COUNSELING CENTER LLC

Organization Subpart: NO

NPI: 1437547007
Last Updated: 2015-01-05
Certification Date:

Details

NameValue
NPI1437547007
Enumeration Date2015-01-05
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SHEILA NICOLE MANSUROV MA, LMHC, SOTP
Title: Owner/Therapist
Phone: 4252986223
Mailing Address 16541 REDMOND WAY # 501C
REDMOND, WA 98052-4492
United States

Phone: 425-298-6223 | Fax:
 
Primary Practice Address 11415 NE 128TH ST STE 100
KIRKLAND, WA 98034-6314
United States

Phone: 425-298-6223 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDWA2039799
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 261QM0801X - Clinic/Center - Mental Health (Including Community Mental Health Center)WAFC 60206027
Yes 261QM0801X - Clinic/Center - Mental Health (Including Community Mental Health Center)WALH 60184919