| NPI | 1124546973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN SEATON WHITE Owner 360-553-1548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WA LW60754230) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2020-08-27 |