Basic Information
| Provider Information | |||||||||
| NPI: | 1417357914 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL WASHINGTON COMPREHENSIVE MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 S 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095754084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 402 S. 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095754084 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2014 | ||||||||
| LastUpdateDate: | 09/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | GOVEIA | ||||||||
| AuthorizedOfficialFirstName: | KRISTYLYNNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 5095754084 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCISW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6060795 | WA | Y | Agencies | Community/Behavioral Health |
No ID Information.