| NPI | 1457120560 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY NOVY Credentialing/Paneling Manager 425-343-4052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-12-29 |
| Last Update Date | 2024-01-02 |