| NPI | 1417118001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE A MATTILA Owner 360-679-2779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA 601665352) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2008-06-17 |