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218-a Main Street Morton WA 98356-0000 | |
(360) 496-6216 | |
(360) 496-6232 |
Full Name | |
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Speciality | Psychologist - Addiction (substance Use Disorder) |
Location | 218-a Main Street, Morton, Washington |
Authorized Official Name and Position | Nicole Quinn (PAYOR CREDENTIALING MANAGER) |
Authorized Official Contact | 4255256715 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 34439 Seattle WA 98124-1439 Ph: (425) 525-6778 | 218-a Main Street Morton WA 98356-0000 Ph: (360) 496-6216 |
NPI Number | 1104024348 |
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Provider Enumeration Date | 07/10/2007 |
Last Update Date | 12/22/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104024348 | NPI | - | NPPES |
602 399 531 | Other | WA | UBI MASTER LICENSE |
1250 | Other | WA | BUSINESS LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |