MEDICARE: GREAT NORTHERN CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER	WA	MENTAL HEALTH THERAPY

General Provider Information

NPI Number	:	1831829605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT NORTHERN CONSULTING

Provider Business Mailing Address
First Line	:	1801 D ST STE 4
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3376
Country	:	US
Telephone Number	:	100-000-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 D ST STE 4
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3376
Country	:	US
Telephone Number	:	253-449-8033
Fax Number	:

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	ELENA CHUMAK
Credential	:
Telephone Number	:	253-292-6391

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “GREAT NORTHERN CONSULTING ” Practice Location

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