| NPI | 1053005066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA L OSBORN Owner 360-627-1359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-10-23 |