Healthcare Provider Details

I. General information

NPI: 1073839957
Provider Name (Legal Business Name): HEALTHY WHOLE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 BAY ST SUITE 24
PORT ORCHARD WA
98366-5242
US

IV. Provider business mailing address

1014 BAY ST SUITE 24
PORT ORCHARD WA
98366-5242
US

V. Phone/Fax

Practice location:
  • Phone: 360-602-0022
  • Fax: 360-335-6432
Mailing address:
  • Phone: 360-602-0022
  • Fax: 360-335-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number18148700
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18148700
License Number StateWA

VIII. Authorized Official

Name: MR. MICHELLE ROSALIA YORK
Title or Position: ADMINISTRATOR, EXECUTIVE DIRECTOR
Credential:
Phone: 360-602-0022