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NPI Code Detail

MEDICARE: COUNTY OF GRANT

MEDICARE: COUNTY OF GRANT
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1689677833
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF GRANT
Provider Business Mailing Address
First Line : 840 E PLUM ST
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1874
Country : US
Telephone Number : 509-765-9239
Fax Number : 509-765-4124
Provider Business Practice Location Address
First Line : 840 E PLUM ST
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1874
Country : US
Telephone Number : 509-765-9239
Fax Number : 509-765-4124
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. LEROY ALLISON
Credential :
Telephone Number : 509-765-9239
Provider Enumeration Date : 05/23/2005
Last Update Date : 12/30/2014

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Directions to “COUNTY OF GRANT ” Practice Location

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