Healthcare Provider Details

I. General information

NPI: 1215707518
Provider Name (Legal Business Name): FAMILY COUNSELING NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W FRANCIS AVE STE F
SPOKANE WA
99205-6361
US

IV. Provider business mailing address

PO BOX 1674
NEWPORT WA
99156-1674
US

V. Phone/Fax

Practice location:
  • Phone: 509-671-0226
  • Fax: 888-314-6684
Mailing address:
  • Phone: 509-671-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOLLY O PHILLIPS
Title or Position: OWNER
Credential: LICSW
Phone: 509-671-0226