| Lone Cypress Behavioral Health , Pllc | |
|
203 W Patison St Ste B Port Hadlock WA 98339-8701 | |
| (360) 251-0898 | |
| (360) 251-0863 |
| Full Name | Lone Cypress Behavioral Health , Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 203 W Patison St Ste B, Port Hadlock, Washington |
| Authorized Official Name and Position | Alicia Beth Kidd (OWNER) |
| Authorized Official Contact | 3602510898 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lone Cypress Behavioral Health , Pllc Po Box 1532 Port Hadlock WA 98339-1532 Ph: (360) 251-0898 | Lone Cypress Behavioral Health , Pllc 203 W Patison St Ste B Port Hadlock WA 98339-8701 Ph: (360) 251-0898 |
| NPI Number | 1295481604 |
|---|---|
| Provider Enumeration Date | 02/24/2022 |
| Last Update Date | 04/24/2022 |
| Certification Date | 04/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295481604 | NPI | - | NPPES |
| 1790731081 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
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