| NPI | 1619194123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVON KELLER Billing Supervisor 360-353-9431 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2024-10-31 |