| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 402 S 4th Ave, Yakima, Washington |
| Authorized Official Name and Position | Jodi Daly (PRESIDENT/CEO) |
| Authorized Official Contact | 5095754084 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 959 Yakima WA 98907-0959 Ph: () - | 402 S 4th Ave Yakima WA 98902 Ph: (509) 575-4084 |
| NPI Number | 1235313024 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 08/12/2023 |
| Certification Date | 08/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235313024 | NPI | - | NPPES |
| 1994458 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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