Basic Information
| Provider Information | |||||||||
| NPI: | 1538604426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY CITIES COUNSELING AND CONSULTATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 W GOWE ST | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980325892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
| FaxNumber: | 2536618644 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 W GOWE ST | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980325892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
| FaxNumber: | 2536618644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2016 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | FISHER | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER, REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 2067317196 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1982909 | 05 | WA | MEDICAID |