# LAKEWOOD CHILD AND FAMILY COUNSELING LLC

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

## Provider details

- **NPI number:** 1952635716
- **Authorized official:** MRS. MICHELLE L KLEKOTA-CHISHOLM MA, LMHC (THERAPIST, OWNER)
- **Authorized official phone:** (253) 617-3559

## Contact information

- **Practice address:** 9311 BRIDGEPORT WAY SW, LAKEWOOD, WA 98499-1570
- **Practice address phone:** (253) 617-3559
- **Practice address fax:** (253) 486-1916
- **Mailing address:** 5409 100TH ST SW UNIT 98765, LAKEWOOD, WA 98496-0836
- **Mailing address phone:** (253) 617-3559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | LH 60231172 | WA | — |
| 101YM0800X | Mental Health Counselor | LH 60231172 | WA | Yes |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |

## Other

- **Enumeration date:** 09/28/2009
- **Last updated:** 07/02/2021