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1711 Main St Vancouver WA 98660-2607 | |
| (360) 200-4481 | |
| (360) 799-4714 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1711 Main St, Vancouver, Washington |
| Authorized Official Name and Position | Katie Grill (OWNER) |
| Authorized Official Contact | 3602004481 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1711 Main St Vancouver WA 98660-2607 Ph: (360) 200-4481 | 1711 Main St Vancouver WA 98660-2607 Ph: (360) 200-4481 |
| NPI Number | 1972090587 |
|---|---|
| Provider Enumeration Date | 04/18/2018 |
| Last Update Date | 12/31/2024 |
| Certification Date | 12/31/2024 |
| Medicare PECOS PAC ID | 8729337795 |
|---|---|
| Medicare Enrollment ID | O20180823003612 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972090587 | NPI | - | NPPES |
| Provider Name | Naomi Kimani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548705320 PECOS PAC ID: 7911283171 Enrollment ID: I20240815000968 |
| Provider Name | Catherine Joan Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1194099200 PECOS PAC ID: 2860933363 Enrollment ID: I20240924004222 |
| Provider Name | Ezra Kilfoil |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376880518 PECOS PAC ID: 4082148689 Enrollment ID: I20241105001319 |
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