Healthcare Provider Details

I. General information

NPI: 1891898953
Provider Name (Legal Business Name): THE EMMAUS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 STEVENS DR
RICHLAND WA
99354-3360
US

IV. Provider business mailing address

PO BOX 1428
RICHLAND WA
99352-1428
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-1430
  • Fax: 509-946-1432
Mailing address:
  • Phone: 509-946-1430
  • Fax: 509-946-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT D OLSON III
Title or Position: EXECUTIVE DIRECTOR
Credential: LMHC
Phone: 509-946-1430