| NPI | 1629967161 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE TEAGUE Credentialing 360-209-4216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-10-16 |