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11802 E Mansfield Ave Suite 1 Spokane Valley WA 99206-4788 | |
(509) 496-2857 | |
(509) 343-1622 |
Full Name | |
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Speciality | Psychologist |
Location | 11802 E Mansfield Ave, Spokane Valley, Washington |
Authorized Official Name and Position | Kimberly Cole (OWNER/MANAGER) |
Authorized Official Contact | 5094962857 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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11802 E Mansfield Ave Suite 1 Spokane Valley WA 99206-4788 Ph: (509) 496-2857 | 11802 E Mansfield Ave Suite 1 Spokane Valley WA 99206-4788 Ph: (509) 496-2857 |
NPI Number | 1437397627 |
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Provider Enumeration Date | 01/27/2009 |
Last Update Date | 02/11/2015 |
Medicare PECOS PAC ID | 8628393022 |
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Medicare Enrollment ID | O20150205001810 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437397627 | NPI | - | NPPES |
7142250 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | 602686727 (Washington) | Primary |
Provider Name | Kimberly L Cole |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1326211731 PECOS PAC ID: 0042399693 Enrollment ID: I20080528000270 |
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