Provider Demographics
NPI:1053782078
Name:REAL LIFE COUNSELING PLLC
Entity type:Organization
Organization Name:REAL LIFE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & CONTRACTING SPECIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-619-2226
Mailing Address - Street 1:1498 SE TECH CENTER PL STE 300
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5509
Mailing Address - Country:US
Mailing Address - Phone:360-619-2226
Mailing Address - Fax:360-326-9691
Practice Address - Street 1:1498 SE TECH CENTER PL STE 300
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5509
Practice Address - Country:US
Practice Address - Phone:360-619-2226
Practice Address - Fax:360-326-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty