Healthcare Provider Details

I. General information

NPI: 1265369730
Provider Name (Legal Business Name): U-DISTRICT MENTAL PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N HAMILTON ST
SPOKANE WA
99202-2045
US

IV. Provider business mailing address

730 N HAMILTON ST
SPOKANE WA
99202-2045
US

V. Phone/Fax

Practice location:
  • Phone: 509-458-7686
  • Fax: 509-808-2164
Mailing address:
  • Phone: 509-458-7686
  • Fax: 509-808-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOHN M MANIX
Title or Position: EMPLOYEE
Credential: LCPC
Phone: 509-954-8242