| NPI | 1689062366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA DENISE SHISSLER Owner 509-808-6151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA MHC.LH.60362453) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2015-01-02 |