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General NPI Number Information
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NPI Number | 1871170498
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Entity Type | Organization
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Legal Business Name | KETTLE RIVER WHOLE LIFE, INC.
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 03/28/2021
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Provider Practice Location Address
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Address Line | 21 LOUIE CREEK DR
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City | CURLEW
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State | WA
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Zip | 99118-9704
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Country | US
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Telephone | 509-207-0082
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Fax | 833-392-1177
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Provider Business Mailing Address
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Address Line | 21 LOUIE CREEK DR
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City | CURLEW
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State | WA
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Zip | 99118-9704
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Country | US
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Telephone | 509-207-0082
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Fax | 833-392-1177
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHRISTY ANN HARVEY
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Credential | LMHC
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Telephone | 509-207-0082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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