| NPI | 1306253067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER ANNE BLACKMORE Owner 360-649-1238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WA MG60354376) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |