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200 Nat Washington Way Ephrata WA 98823 | |
(509) 764-7474 | |
(509) 764-7480 |
Full Name | |
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Speciality | Counselor |
Location | 200 Nat Washington Way, Ephrata, Washington |
Authorized Official Name and Position | Debora Renee Holt (LICENSED MENTAL HEALTH COUNSELOR/OW) |
Authorized Official Contact | 5097647474 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 65 200 Nat Washington Way Ephrata WA 98823 Ph: (509) 764-7474 | 200 Nat Washington Way Ephrata WA 98823 Ph: (509) 764-7474 |
NPI Number | 1053317958 |
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Provider Enumeration Date | 06/24/2005 |
Last Update Date | 03/12/2024 |
Medicare PECOS PAC ID | 0840635991 |
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Medicare Enrollment ID | O20240228001642 |
Identifier | Type | State | Issuer |
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1053317958 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Debora R Holt |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1861533556 PECOS PAC ID: 0749627529 Enrollment ID: I20240328002762 |