Healthcare Provider Details

I. General information

NPI: 1790707776
Provider Name (Legal Business Name): QUALITY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 7TH STREET
CLARKSTON WA
99403
US

IV. Provider business mailing address

900 7TH STREET
CLARKSTON WA
99403
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-3341
  • Fax: 509-769-6057
Mailing address:
  • Phone: 509-758-3341
  • Fax: 509-769-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number600425853
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number011
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number600425853
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIKA M. GWINN
Title or Position: CLINICAL DIRECTOR
Credential: MA, LMHC, DMHP
Phone: 509-758-3341