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SHADES OF GRACE EMDR, EQUINE, IFS THERAPY, PLLC

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Company Details

Legal Name: SHADES OF GRACE EMDR, EQUINE, IFS THERAPY, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: July 28th 2022
Expiration date: 31 Jul 2026
UBI Number: 604 955 307
ZIP code: 98383
City: Silverdale
County: KITSAP
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 9920 LEVIN RD NW, STE 101, SILVERDALE, WA, 98383-7790, UNITED STATES
Principal Office Mailing Address: Google Maps Logo 599 NW WALKER RD, POULSBO, WA, 98370-8140, UNITED STATES

Contact Details

E-Mail: DRRENEEMILLER@GMAIL.COM
Phone Number: +1 360-451-9253

Nature of Business

Professional, Scientific & Technical Services, Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
UNITED STATES CORPORATION AGENTS INC Registered Agent 14205 SE 36TH ST STE 100, BELLEVUE, WA, 98006-1553, UNITED STATES

Key Officers & Management

Name Role Address
RENEE MILLER Executor 599 NW WALKER RD, POULSBO, WA, 98370-8140, UNITED STATES
RENEE MILLER Governing Person 599 NW WALKER RD, POULSBO, WA, 98370-8140, UNITED STATES

National Provider Identifier

NPI Number:
1609585595
Certification Date:
2022-11-18

Authorized Person:

Name:
DR. RENEE MILLER
Role:
OWNER, CLINICIAN, PROVIDER
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

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