| NPI | 1972034122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE WILLIAM WETHERALD Counselor 360-385-3866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA CP60235589) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |