| NPI | 1104947142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NORMAN FREDERIC PETERSON President 360-452-8991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |