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General NPI Number Information
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NPI Number | 1932910684
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Entity Type | Organization
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Legal Business Name | PRINCIPAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 21525 SR 410 E STE A
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City | BONNEY LAKE
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State | WA
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Zip | 98391-4101
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Country | US
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Telephone | 253-499-6999
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Fax | 888-440-5188
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Provider Business Mailing Address
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Address Line | PO BOX 7531
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City | BONNEY LAKE
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State | WA
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Zip | 98391-0924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MR.
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Name | BIEN NGUYEN
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Credential |
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Telephone | 253-499-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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