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1330a S 2nd St Ste 102 Mount Vernon WA 98273-4822 | |
| (360) 770-8487 | |
| (360) 336-3315 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1330a S 2nd St Ste 102, Mount Vernon, Washington |
| Authorized Official Name and Position | Eric R Johnson (OWNER) |
| Authorized Official Contact | 3607708487 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1330a S 2nd St Ste 102 Mount Vernon WA 98273-4822 Ph: (360) 770-8487 | 1330a S 2nd St Ste 102 Mount Vernon WA 98273-4822 Ph: (360) 770-8487 |
| NPI Number | 1851427694 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 07/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851427694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LH00003649 (Washington) | Primary |
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