Healthcare Provider Details

I. General information

NPI: 1790835189
Provider Name (Legal Business Name): NORTH PINES COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 PINES RD N STE 250
SPOKANE VLY WA
99206-4993
US

IV. Provider business mailing address

1005 PINES RD N STE 250
SPOKANE VLY WA
99206-4993
US

V. Phone/Fax

Practice location:
  • Phone: 509-927-1194
  • Fax: 509-927-8819
Mailing address:
  • Phone: 509-927-1194
  • Fax: 509-927-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number943
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00005843
License Number StateWA

VIII. Authorized Official

Name: DR. ROB NEILS
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 509-927-1194