Organization
HIGHLAND CLINICAL SUPPORT, LLC
Active
Other names
Highland Psychological Services
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN MARIE WRUK (MEMBER MANAGER)
(815) 954-4083
Entity
Organization
Contact information
Practice address
3400 HARBOR AVE SW STE 207, SEATTLE, WA 98126-2396
(206) 290-5954
Mailing address
PO BOX 46564, SEATTLE, WA 98146-0564
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
363AM0700X
Medical Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891740197
—
WA
Enumeration date
01/30/2020
Last updated
01/30/2020
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