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General NPI Number Information
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NPI Number | 1336651470
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Entity Type | Organization
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Legal Business Name | PAX FAMILY COUNSELING
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 10/30/2017
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Provider Practice Location Address
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Address Line | 601 MAIN ST STE 503
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City | VANCOUVER
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State | WA
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Zip | 98660-3414
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Country | US
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Telephone | 360-619-2275
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Fax |
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Provider Business Mailing Address
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Address Line | 506 W 12TH WAY
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City | LA CENTER
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State | WA
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Zip | 98629-4267
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Country | US
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Telephone | 360-619-2275
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY DE LA TORRE
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Credential | LMHC
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Telephone | 360-619-2275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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