| NPI | 1417081456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT WEAVER Clinical Director 360-802-0446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA CP00002621) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-08-22 |