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425 E Main St Ste 600 Othello WA 99344-1146 | |
| (509) 488-5611 | |
| (509) 488-0166 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 425 E Main St Ste 600, Othello, Washington |
| Authorized Official Name and Position | Vicki Guse (ADMINISTRATOR) |
| Authorized Official Contact | 5094884074 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
425 E Main St Ste 600 Othello WA 99344-1146 Ph: (509) 488-5611 | 425 E Main St Ste 600 Othello WA 99344-1146 Ph: (509) 488-5611 |
| NPI Number | 1487905154 |
|---|---|
| Provider Enumeration Date | 09/21/2012 |
| Last Update Date | 12/17/2019 |
| Certification Date | 12/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487905154 | NPI | - | NPPES |
| 1981745 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 008 (Washington) | Primary |