| NPI | 1265982763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RYAN FROST Counselor 360-676-4485 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry | |
| 251S00000X Community/Behavioral Health (Licence: WA CO60545681) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2025-01-07 |