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750 George Washington Way Ste 8 Richland WA 99352-4247 | |
| (509) 676-6735 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 750 George Washington Way Ste 8, Richland, Washington |
| Authorized Official Name and Position | Jessica Marie Wallace (OWNER) |
| Authorized Official Contact | 5096766735 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
750 George Washington Way Ste 8 Richland WA 99352-4247 Ph: (509) 676-6735 | 750 George Washington Way Ste 8 Richland WA 99352-4247 Ph: (509) 676-6735 |
| NPI Number | 1841846664 |
|---|---|
| Provider Enumeration Date | 08/16/2019 |
| Last Update Date | 10/13/2022 |
| Certification Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841846664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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