Organization
FIREWEED THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAILE GRACE DAVELAAR LMFT (OWNER)
(509) 676-6009
Entity
Organization
Contact information
Practice address
10090 MAIN ST APT H, PESHASTIN, WA 98847-9770
(509) 676-6009
(509) 676-6009
Mailing address
9041 DERBY CANYON RD, PESHASTIN, WA 98847-9754
(509) 679-8749
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1366758864
PERSONAL NPI
—
05
—
2050159
—
WA
Enumeration date
10/15/2018
Last updated
10/15/2018
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