| NPI | 1629120159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELCEY SYMONS Admin Supervisor 206-545-2387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WA 117700) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WA 035) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA 17087600) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA 17087500) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2018-09-26 |