Healthcare Provider Details

I. General information

NPI: 1821524422
Provider Name (Legal Business Name): NORTHWEST RESOURCES II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LILLY RD NE STE C
OLYMPIA WA
98506-5080
US

IV. Provider business mailing address

2708 WESTMOOR CT SW
OLYMPIA WA
98502-5754
US

V. Phone/Fax

Practice location:
  • Phone: 360-918-8336
  • Fax: 360-972-2152
Mailing address:
  • Phone: 360-943-8810
  • Fax: 360-943-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number162700
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number162700
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number162700
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number162700
License Number StateWA

VIII. Authorized Official

Name: DENNIS R NEAL
Title or Position: CEO
Credential: CDP, C.AD
Phone: 360-943-8810