Licensed2listen | |
1339 Commerce Ave Suite 305 Longview WA 98632-5347 | |
(360) 703-7171 | |
Not Available |
Full Name | Licensed2listen |
---|---|
Speciality | Community/behavioral Health |
Location | 1339 Commerce Ave, Longview, Washington |
Authorized Official Name and Position | Colette Annette Giovanniello (MARRIAGE AND FAMILY THERAPIST) |
Authorized Official Contact | 3607037171 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Licensed2listen 1339 Commerce Ave Suite 305 Longview WA 98632 Ph: (360) 703-7171 | Licensed2listen 1339 Commerce Ave Suite 305 Longview WA 98632-5347 Ph: (360) 703-7171 |
NPI Number | 1609168889 |
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Provider Enumeration Date | 05/06/2011 |
Last Update Date | 06/09/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609168889 | NPI | - | NPPES |
603008337 | Other | WA | UBI TAX IDENTIFICATION |
G869183V | Other | WA | PAC CODE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | LF 603008337 (Wisconsin) | Primary |
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