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General NPI Number Information
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NPI Number | 1043636442
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Entity Type | Organization
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Legal Business Name | CHEHALIS TSAPOWUM MENTAL HEALTH
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 420 HOWANUT RD
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City | OAKVILLE
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State | WA
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Zip | 98568-9659
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Country | US
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Telephone | 360-709-1628
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Fax | 360-273-8957
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Provider Business Mailing Address
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Address Line | 420 HOWANUT RD
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City | OAKVILLE
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State | WA
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Zip | 98568-9659
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Country | US
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Telephone | 360-709-1628
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Fax | 360-273-8957
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Authorized Official
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Title or Position | SYSTEM ADMINISTRATOR
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Name | GARY GOODWIN
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Credential |
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Telephone | 360-867-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 14 0096 00
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License Number State | WA
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