MEDICARE: OKANOGAN BEHAVIORAL HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency
3	101YM0800X	Mental Health Counselor	602 200 591	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154324929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKANOGAN BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	1007 KOALA DR
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-9247
Country	:	US
Telephone Number	:	509-826-6191
Fax Number	:	509-826-3029

Provider Business Practice Location Address
First Line	:	1007 KOALA DR
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-9247
Country	:	US
Telephone Number	:	509-826-6191
Fax Number	:	509-826-3029

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID MCCLAY
Credential	:
Telephone Number	:	509-826-6191

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/03/2024

Similar Medicare Providers

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Practice Location Address:

1007 KOALA AVE
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98841-9247

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1255440376 — MR. BENJAMIN THEODORE DESCOTEAUX M.ED.
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1007 KOALA AVE
OMAK, WA
98841-9247

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1477638716 — LESLIE C TREGILLUS MD
Practice Location Address:

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OMAK, WA
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1548338007 — MS. PRISCILLA TRAGESSER HONE LMHC, CDP
Practice Location Address:

1007 KOALA DR
OMAK, WA
98841-9247

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1740333863 — GRACIE ABANGAN
Practice Location Address:

1007 KOALA AVE
OMAK, WA
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1134272263 — JANICE BAUER
Practice Location Address:

1007 KOALA AVE
OMAK, WA
98841-9247

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