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General NPI Number Information
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NPI Number | 1124567177
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW MENTAL HEALTH
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 3100 NW BUCKLIN HILL RD STE 246
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City | SILVERDALE
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State | WA
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Zip | 98383-8365
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Country | US
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Telephone | 208-841-8559
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4074
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City | SOUTH COLBY
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State | WA
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Zip | 98384-0074
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Country | US
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Telephone | 208-841-8559
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. KELLIE KRISTINA ROBISON
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Credential | LICSW
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Telephone | 208-841-8559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LW60127859
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License Number State | WA
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