Provider Demographics
NPI:1902241623
Name:MILL CREEK FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:MILL CREEK FAMILY SERVICES, LLC
Other - Org Name:MILL CREEK FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:HORNER
Authorized Official - Last Name:URIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:425-357-9111
Mailing Address - Street 1:16000 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1742
Mailing Address - Country:US
Mailing Address - Phone:425-357-9111
Mailing Address - Fax:425-357-9111
Practice Address - Street 1:16000 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 360
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1742
Practice Address - Country:US
Practice Address - Phone:425-357-9111
Practice Address - Fax:425-357-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty