# FIREWEED THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821564063
- **Authorized official:** MAILE GRACE DAVELAAR LMFT (OWNER)
- **Authorized official phone:** (509) 676-6009

## Contact information

- **Practice address:** 10090 MAIN ST APT H, PESHASTIN, WA 98847-9770
- **Practice address phone:** (509) 676-6009
- **Practice address fax:** (509) 676-6009
- **Mailing address:** 9041 DERBY CANYON RD, PESHASTIN, WA 98847-9754
- **Mailing address phone:** (509) 679-8749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 10/15/2018
- **Last updated:** 10/15/2018