| NPI | 1285047258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA DOUGLASS Clinical Supervisor 360-992-2614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA PY60267694) |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2014-06-08 |