| NPI | 1215501903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAGE L WILLIS Psychologist 360-812-1505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-03-26 |