Provider Demographics
NPI:1437547007
Name:A NEW BEGINNING COUNSELING CENTER LLC
Entity type:Organization
Organization Name:A NEW BEGINNING COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MANSUROV
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, SOTP
Authorized Official - Phone:425-298-6223
Mailing Address - Street 1:16541 REDMOND WAY # 501C
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4492
Mailing Address - Country:US
Mailing Address - Phone:425-298-6223
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6314
Practice Address - Country:US
Practice Address - Phone:425-298-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFC 60206027261QM0801X
WALH 60184919261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2039799Medicaid