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General NPI Number Information
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NPI Number | 1699974113
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Entity Type | Organization
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Legal Business Name | PALOUSE COUNSELING SERVICE, PLLC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 10/05/2009
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Provider Practice Location Address
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Address Line | 120 E BIRCH ST STE 9
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City | WALLA WALLA
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State | WA
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Zip | 99362-3054
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Country | US
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Telephone | 509-527-8451
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Fax | 509-527-0942
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Provider Business Mailing Address
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Address Line | 120 E BIRCH ST STE 9
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City | WALLA WALLA
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State | WA
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Zip | 99362-3054
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Country | US
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Telephone | 509-527-8451
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Fax | 509-527-0942
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Authorized Official
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Title or Position | MEMBER
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Name | LAURIE HEIKKENEN
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Credential | LICSW
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Telephone | 509-527-8451
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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 | LW00008520
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License Number State | WA
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