Healthcare Provider Details

I. General information

NPI: 1740759935
Provider Name (Legal Business Name): COURTNEY CLARK-RIVERA CALAWAY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 N NEVADA ST
SPOKANE WA
99218-1145
US

IV. Provider business mailing address

9921 N NEVADA ST
SPOKANE WA
99218-1145
US

V. Phone/Fax

Practice location:
  • Phone: 509-581-2690
  • Fax:
Mailing address:
  • Phone: 509-581-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61658103
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: