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General NPI Number Information
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NPI Number | 1609331206
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE THERAPIES WALLA WALLA, LLC
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 19 E BIRCH ST STE 104
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City | WALLA WALLA
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State | WA
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Zip | 99362-3205
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Country | US
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Telephone | 773-349-6778
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Fax |
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Provider Business Mailing Address
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Address Line | 19 E BIRCH ST STE 104
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City | WALLA WALLA
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State | WA
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Zip | 99362-3205
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Country | US
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Telephone | 773-349-6778
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELISE OCONNELL
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Credential | LICSW
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Telephone | 773-349-6778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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