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General NPI Number Information
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NPI Number | 1114398070
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 1201 S PROCTOR ST
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City | TACOMA
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State | WA
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Zip | 98405-2047
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Country | US
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Telephone | 253-396-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S PROCTOR ST
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City | TACOMA
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State | WA
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Zip | 98405-2047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADULT MEDICAL SERVICES
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Name | ANTOINNETTE WILLIAMS
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Credential | MHA, MHP
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Telephone | 253-396-5817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 251500000X
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 25
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License Number State | WA
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