Healthcare Provider Details

I. General information

NPI: 1376819441
Provider Name (Legal Business Name): HAYES-ELLINGWOOD COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 N DIVISION ST STE 304
SPOKANE WA
99207-1613
US

IV. Provider business mailing address

4407 N DIVISION ST STE 304
SPOKANE WA
99207-1613
US

V. Phone/Fax

Practice location:
  • Phone: 509-483-1866
  • Fax: 509-483-1876
Mailing address:
  • Phone: 509-483-1866
  • Fax: 509-483-1876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00010674
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00008613
License Number StateWA

VIII. Authorized Official

Name: MRS. RIANN KATHLEEN ELLINGWOOD
Title or Position: CO-OWNER, THERAPIST
Credential: M.S., LMHC
Phone: 509-483-1866