Organization
LICENSED2LISTEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLETTE ANNETTE GIOVANNIELLO M.A., LMFT (MARRIAGE AND FAMILY THERAPIST)
(360) 703-7171
Entity
Organization
Contact information
Practice address
1339 COMMERCE AVE, SUITE 305, LONGVIEW, WA 98632-5347
(360) 703-7171
Mailing address
1339 COMMERCE AVE, SUITE 305, LONGVIEW, WA 98632
(360) 703-7171
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LF 603008337
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
603008337
UBI TAX IDENTIFICATION
WA
01
—
G869183V
PAC CODE
WA
Enumeration date
05/06/2011
Last updated
06/09/2011
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