| |
9124 Gravelly Lake Dr Sw Lakes Plaza Suite 101 Lakewood WA 98499-3198 | |
(253) 503-0236 | |
(253) 503-0982 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 9124 Gravelly Lake Dr Sw, Lakewood, Washington |
Authorized Official Name and Position | Jennifer Hortense Ferguson (CEO) |
Authorized Official Contact | 2535030236 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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9124 Gravelly Lake Dr Sw Lakes Plaza Suite 101 Lakewood WA 98499-3198 Ph: (253) 503-0236 | 9124 Gravelly Lake Dr Sw Lakes Plaza Suite 101 Lakewood WA 98499-3198 Ph: (253) 503-0236 |
NPI Number | 1033488598 |
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Provider Enumeration Date | 12/29/2011 |
Last Update Date | 12/29/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033488598 | NPI | - | NPPES |
331-8907 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 602933664 (Washington) | Primary |
Paul Kenneth Henry Med Lmhc Ps Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9101 Bridgeport Way Sw Ste D2, Lakewood, WA 98499 Phone: 253-394-6045 | |
Lakewood Wellness Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10310 Gravelly Lake Dr Sw Ste B, Lakewood, WA 98499 Phone: 253-888-3405 | |