Healthcare Provider Details

I. General information

NPI: 1871170498
Provider Name (Legal Business Name): KETTLE RIVER WHOLE LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LOUIE CREEK DR
CURLEW WA
99118-9704
US

IV. Provider business mailing address

21 LOUIE CREEK DR
CURLEW WA
99118-9704
US

V. Phone/Fax

Practice location:
  • Phone: 509-207-0082
  • Fax: 833-392-1177
Mailing address:
  • Phone: 509-207-0082
  • Fax: 833-392-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY ANN HARVEY
Title or Position: VICE PRESIDENT
Credential: LMHC
Phone: 509-207-0082