| NPI | 1598134595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE ELLEN PUEBLA Therapist 360-809-2971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY 60107671) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WA LF 60300097) |
| Enumeration Date | 2015-09-19 |
| Last Update Date | 2015-09-19 |