| NPI | 1144319781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI LODGE Executive Director 509-325-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 32055600) |
| 101YM0800X Counselor, Mental Health (Licence: WA 184) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2016-01-07 |