Healthcare Provider Details

I. General information

NPI: 1568249795
Provider Name (Legal Business Name): RELATIONSHIP ADVANTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 E 61ST AVE
SPOKANE WA
99223-8038
US

IV. Provider business mailing address

3727 E 61ST AVE
SPOKANE WA
99223-8038
US

V. Phone/Fax

Practice location:
  • Phone: 509-389-4765
  • Fax:
Mailing address:
  • Phone: 509-389-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GINGER M JOHNSON
Title or Position: SUPERVISOR
Credential:
Phone: 509-389-4765