Healthcare Provider Details

I. General information

NPI: 1548887383
Provider Name (Legal Business Name): SWIFTWATER COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N OAKES AVE STE A2
CLE ELUM WA
98922-1273
US

IV. Provider business mailing address

PO BOX 346
NACHES WA
98937-0346
US

V. Phone/Fax

Practice location:
  • Phone: 509-961-0547
  • Fax:
Mailing address:
  • Phone: 509-961-0547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLY MANKUS
Title or Position: PROVIDER/OWNER
Credential: MSW
Phone: 509-961-0547