Healthcare Provider Details

I. General information

NPI: 1477694727
Provider Name (Legal Business Name): SERENITY OUTPATIENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W NORTHWEST BLVD SUITE C
SPOKANE WA
99205
US

IV. Provider business mailing address

1717 W NORTHWEST BLVD SUITE C
SPOKANE WA
99205
US

V. Phone/Fax

Practice location:
  • Phone: 509-325-0777
  • Fax: 509-325-3464
Mailing address:
  • Phone: 509-325-0777
  • Fax: 509-325-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00004728
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00009556
License Number StateWA

VIII. Authorized Official

Name: SHERI LYNN HOVESKELAND
Title or Position: OWNER
Credential: MS LMHC CDP
Phone: 509-325-0777