Healthcare Provider Details

I. General information

NPI: 1306775374
Provider Name (Legal Business Name): PHINEHAS K NGANGA LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 S JENNINGS AVE
SAINT JOHN WA
99171-9680
US

IV. Provider business mailing address

409 S JENNINGS AVE
SAINT JOHN WA
99171-9680
US

V. Phone/Fax

Practice location:
  • Phone: 509-994-8921
  • Fax:
Mailing address:
  • Phone: 509-994-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61644697
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: