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8907 Gravelly Lake Dr Sw Ste D Lakewood WA 98499-3152 | |
(253) 581-5556 | |
Not Available |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 8907 Gravelly Lake Dr Sw Ste D, Lakewood, Washington |
Authorized Official Name and Position | Cynthia Potts (CEO) |
Authorized Official Contact | 2535815556 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8907 Gravelly Lake Dr Sw Ste D Lakewood WA 98499-3152 Ph: () - | 8907 Gravelly Lake Dr Sw Ste D Lakewood WA 98499-3152 Ph: (253) 581-5556 |
NPI Number | 1053467944 |
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Provider Enumeration Date | 01/25/2007 |
Last Update Date | 08/07/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053467944 | NPI | - | NPPES |
1993989 | Medicaid | WA | |
1992510 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 27036400 (Washington) | Primary |
251S00000X | Community/behavioral Health | 27124700 (Washington) | Secondary |
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 | |