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General NPI Number Information
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NPI Number | 1275823536
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Entity Type | Organization
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Legal Business Name | PINNACLE PEAK INSTITUTE INC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1880 BARNES BLVD SW STE B-1
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City | TUMWATER
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State | WA
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Zip | 98512-1435
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Country | US
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Telephone | 360-704-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 1880 BARNES BLVD SW STE B-1
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City | TUMWATER
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State | WA
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Zip | 98512-1435
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Country | US
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Telephone | 360-704-0086
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CONNIE L THOMPSON
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Credential | PH.D
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Telephone | 360-628-1256
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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 | LH60174986
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License Number State | WA
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Taxonomy #2
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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 | LH60174986
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 34 1527 00
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License Number State | WA
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