| Integrative Therapies Walla Walla, Llc | |
|
19 E Birch St Ste 104 Walla Walla WA 99362-3205 | |
| (773) 349-6778 | |
| Not Available |
| Full Name | Integrative Therapies Walla Walla, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 19 E Birch St Ste 104, Walla Walla, Washington |
| Authorized Official Name and Position | Elise Oconnell (OWNER) |
| Authorized Official Contact | 7733496778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Therapies Walla Walla, Llc 19 E Birch St Ste 104 Walla Walla WA 99362-3205 Ph: (773) 349-6778 | Integrative Therapies Walla Walla, Llc 19 E Birch St Ste 104 Walla Walla WA 99362-3205 Ph: (773) 349-6778 |
| NPI Number | 1609331206 |
|---|---|
| Provider Enumeration Date | 02/07/2019 |
| Last Update Date | 07/26/2019 |
| Medicare PECOS PAC ID | 7517296684 |
|---|---|
| Medicare Enrollment ID | O20190916001352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609331206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Elise K Oconnell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548592009 PECOS PAC ID: 6305020363 Enrollment ID: I20190916001877 |
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