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425 E Main St Ste 600 Othello WA 99344-1146 | |
(509) 488-4074 | |
(509) 488-0166 |
Full Name | |
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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 |
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425 E Main St Ste 600 Othello WA 99344-1146 Ph: (509) 488-4074 | 425 E Main St Ste 600 Othello WA 99344-1146 Ph: (509) 488-4074 |
NPI Number | 1407855653 |
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Provider Enumeration Date | 07/19/2005 |
Last Update Date | 12/17/2019 |
Certification Date | 12/17/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407855653 | NPI | - | NPPES |
1981745 | Medicaid | WA | |
1990589 | Medicaid | WA |