1699974113 NPI number — PALOUSE COUNSELING SERVICE, PLLC

Table of content: (NPI 1699974113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699974113 NPI number — PALOUSE COUNSELING SERVICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALOUSE COUNSELING SERVICE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PALOUSE COUNSELING, PLLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699974113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 E BIRCH ST STE 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362-3054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-527-8451
Provider Business Mailing Address Fax Number:
509-527-0942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E BIRCH ST STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-527-8451
Provider Business Practice Location Address Fax Number:
509-527-0942
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEIKKENEN
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
509-527-8451

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LW00008520 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GAB22457 . This is a "GROUP PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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