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Organization

BUENA VIDA COUNSELING PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHRISTINA MARIE WELLMAN LMHC (OWNER/MANAGING MEMBER)
(360) 358-2085
Entity
Organization

Contact information

Practice address
2146 W RAILROAD AVE STE A, SHELTON, WA 98584-7126
(360) 358-2085
(360) 485-4964
Mailing address
PO BOX 541, SHELTON, WA 98584-0541

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2155565
WA
Enumeration date
11/07/2019
Last updated
07/12/2024
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