| NPI | 1629589866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY J LANDIS Owner 360-477-5668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WA LW60524212) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |