Healthcare Provider Details

I. General information

NPI: 1427236504
Provider Name (Legal Business Name): MANITO PRESBYTERIAN CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 30TH AVE
SPOKANE WA
99203-2507
US

IV. Provider business mailing address

401 E 30TH AVE
SPOKANE WA
99203-2507
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-3559
  • Fax: 509-838-1554
Mailing address:
  • Phone: 509-838-3559
  • Fax: 509-838-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLF00001121 020705
License Number StateWA

VIII. Authorized Official

Name: MS. CYNTHIA S CARTER
Title or Position: COUNSELING MINISTRY DIRECTOR
Credential: LMFT
Phone: 509-838-3559