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General NPI Number Information
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NPI Number | 1437557691
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Entity Type | Organization
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Legal Business Name | CEDAR RIVER PSYCHOTHERAPY & RECOVERY LLC
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 119 PELLY AVE N
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City | RENTON
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State | WA
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Zip | 98057-5714
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Country | US
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Telephone | 206-388-8203
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Fax |
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Provider Business Mailing Address
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Address Line | 119 PELLY AVE N
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City | RENTON
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State | WA
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Zip | 98057-5714
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Country | US
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Telephone | 206-388-8203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SUSAN KAY MOYNIHAN
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Credential | LMHC
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Telephone | 206-388-8203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LH00008596
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License Number State | WA
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