Healthcare Provider Details

I. General information

NPI: 1972156297
Provider Name (Legal Business Name): CANYONVIEW FAMILY PSYCHIATRY, PLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N CENTER PKWY STE N197
KENNEWICK WA
99336-7160
US

IV. Provider business mailing address

1030 N CENTER PKWY STE N197
KENNEWICK WA
99336-7160
US

V. Phone/Fax

Practice location:
  • Phone: 509-957-2130
  • Fax: 509-957-2096
Mailing address:
  • Phone: 509-957-2130
  • Fax: 509-957-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY GRAHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 509-957-2130