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107 W Lake Street Suite C Medical Lake WA 99022 | |
| (509) 721-0290 | |
| (509) 565-3025 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 107 W Lake Street, Medical Lake, Washington |
| Authorized Official Name and Position | Melisa Holdway (OWNER) |
| Authorized Official Contact | 5095650686 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 997 Medical Lake WA 99022-0997 Ph: (509) 721-0290 | 107 W Lake Street Suite C Medical Lake WA 99022 Ph: (509) 721-0290 |
| NPI Number | 1407668783 |
|---|---|
| Provider Enumeration Date | 01/23/2025 |
| Last Update Date | 01/24/2025 |
| Certification Date | 01/24/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407668783 | NPI | - | NPPES |
| 1013415223 | Other | NPI | |
| 1699091868 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Compassion First Psychiatry Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14208 S Shoreview Dr, Medical Lake, WA 99022 Phone: 509-263-8792 |