# HIGHLAND CLINICAL SUPPORT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Highland Psychological Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811528664
- **Authorized official:** KATHLEEN MARIE WRUK (MEMBER MANAGER)
- **Authorized official phone:** (815) 954-4083

## Contact information

- **Practice address:** 3400 HARBOR AVE SW STE 207, SEATTLE, WA 98126-2396
- **Practice address phone:** (206) 290-5954
- **Mailing address:** PO BOX 46564, SEATTLE, WA 98146-0564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103T00000X | Psychologist | — | NULL | Yes |
| 103T00000X | Psychologist | — | — | Yes |
| 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

- **Enumeration date:** 01/30/2020
- **Last updated:** 01/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1891740197 | — | WA |