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Organization
HIGHLAND CLINICAL SUPPORT, LLC
Active
Organization
HIGHLAND CLINICAL SUPPORT, LLC
Active
Other names
Highland Psychological Services
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN MARIE WRUK (MEMBER MANAGER)
(815) 954-4083
Entity
Organization
Contact information
Practice address
3400 HARBOR AVE SW STE 207, SEATTLE, WA 98126-2396
(206) 290-5954
Mailing address
PO BOX 46564, SEATTLE, WA 98146-0564
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
NULL
103T00000X
Psychologist
Primary
—
—
103TA0700X
Adult Development & Aging Psychologist
—
NULL
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
NULL
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
NULL
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
NULL
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
NULL
103TF0000X
Family Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
NULL
103TP0016X
Prescribing (Medical) Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
NULL
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891740197
—
WA
Enumeration date
01/30/2020
Last updated
01/30/2020
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