| NPI | 1912515917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA G MCKAY Practice Manager 360-736-6778 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-07-16 |