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General NPI Number Information
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NPI Number | 1114645868
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Entity Type | Organization
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Legal Business Name | NORTHWEST CREDIBLE MESSENGERS LLC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 500 S 336TH ST STE 102
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6389
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Country | US
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Telephone | 206-261-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 3812 LANYARD DR NE
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City | LACEY
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State | WA
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Zip | 98516-1333
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Country | US
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Telephone | 206-261-2410
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JASON J CLARK
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Credential |
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Telephone | 206-261-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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