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General NPI Number Information
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NPI Number | 1245507664
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Entity Type | Organization
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Legal Business Name | KORSGAARD MENTAL HEALTH, INC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 140 S 140 ARTHUR ST STE 415
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City | SPOKANE
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State | WA
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Zip | 99202-2220
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Country | US
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Telephone | 509-389-5794
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Fax | 509-533-0627
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Provider Business Mailing Address
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Address Line | 140 S ARTHUR ST STE 670
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City | SPOKANE
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State | WA
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Zip | 99202-2204
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Country | US
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Telephone | 509-389-5794
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Fax | 509-533-9627
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | MR. CHRISTOPHER PATRICK KORSGAARD
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Credential | ARNP
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Telephone | 509-389-5794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP30007598
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License Number State | WA
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