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NPI Code Detail

MEDICARE: WILLAPA COUNSELING CENTER

MEDICARE: WILLAPA COUNSELING CENTER
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
1261QH0100XHealth Service Clinic/Center
2261QP2300XPrimary Care Clinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)J600618510WA

Other Identifiers

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

General Provider Information

NPI Number : 1174570949
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLAPA COUNSELING CENTER
Provider Business Mailing Address
First Line : 2204 PACIFIC AVE N
Second Line :
City : LONG BEACH
State : WA
Zip : 98631-3300
Country : US
Telephone Number : 360-642-3787
Fax Number : 360-642-2096
Provider Business Practice Location Address
First Line : 2204 PACIFIC AVE N
Second Line :
City : LONG BEACH
State : WA
Zip : 98631-3300
Country : US
Telephone Number : 360-642-3787
Fax Number : 360-642-2096
Authorized Official
Title or Position : PROVIDER ENROLLMENT
Name : LINDSEY MATZEN
Credential :
Telephone Number : 360-642-3783
Provider Enumeration Date : 05/27/2006
Last Update Date : 10/17/2022

Similar Medicare Providers

1942300736 — ROY W SCHLEGEL MD
Practice Location Address:
2204 PACIFIC AVE N
LONG BEACH, WA
98631-3300
Practice Phone: 606-423-7873
Practice Fax: 360-642-2096
1699854299 — MS. MARY ANNE CHRISTINE MURRAY ARNP
Practice Location Address:
2204 PACIFIC AVE N
LONG BEACH, WA
98631-3300
Practice Phone: 360-642-3787
Practice Fax: 360-642-2096
1598823072 — DAVID LEROY NICHOLSON-KLINGERMAN SR. MA LPC, LMHC, CMHS
Practice Location Address:
2204 PACIFIC AVE N
LONG BEACH, WA
98631-3300
Practice Phone: 360-642-3787
Practice Fax: 360-642-2096
1871650630 — ERIN RAE LEVAN M.ED., LMHC
Practice Location Address:
2204 PACIFIC AVE N
LONG BEACH, WA
98631-3300
Practice Phone: 360-642-3787
Practice Fax:
1366578338 — PAULINE S MEAD MSN, APRN, PMHNP
Practice Location Address:
2204 PACIFIC AVE N
LONG BEACH, WA
98631-3300
Practice Phone: 360-642-3787
Practice Fax:
1497928055 — AMY DENNISE TRIPLETT
Practice Location Address:
2204 PACIFIC AVE N
LONG BEACH, WA
98631-3300
Practice Phone: 360-642-3787
Practice Fax: 360-875-4150

Directions to “WILLAPA COUNSELING CENTER ” Practice Location

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