Healthcare Provider Details

I. General information

NPI: 1568834703
Provider Name (Legal Business Name): INTERNAL ACCEPTANCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 NW BOISTFORT ST
CHEHALIS WA
98532-2003
US

IV. Provider business mailing address

6322 201ST AVE
CENTRALIA WA
98531
US

V. Phone/Fax

Practice location:
  • Phone: 360-349-1544
  • Fax: 844-270-5866
Mailing address:
  • Phone: 360-970-8778
  • Fax: 844-270-5866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH6061175
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMC60449144
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberCO60332418
License Number StateWA

VIII. Authorized Official

Name: MRS. MARLA KAY MOUNT
Title or Position: OWNER / PROVIDER
Credential: MA
Phone: 360-970-8778