Healthcare Provider Details

I. General information

NPI: 1396399325
Provider Name (Legal Business Name): NEW PULSE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S HUSSEY ST
WALLA WALLA WA
99362-8517
US

IV. Provider business mailing address

5 W ALDER ST STE 315
WALLA WALLA WA
99362-2863
US

V. Phone/Fax

Practice location:
  • Phone: 509-520-2701
  • Fax:
Mailing address:
  • Phone: 509-520-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JANALEE WAGNER
Title or Position: CLINICAL SOCIAL WORKER
Credential: DSW, MSW, LICSW
Phone: 509-240-9546