| NPI | 1053950832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JA-ANGEL DEWALT Billing Lead 360-377-3776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical | |
| 103TF0000X Psychologist, Family | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 101Y00000X Counselor | |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2020-01-02 |