Provider Demographics
NPI:1053467944
Name:HUMAN SERVICES RESEARCH AND TRAINING CONSORTIUM
Entity Type:Organization
Organization Name:HUMAN SERVICES RESEARCH AND TRAINING CONSORTIUM
Other - Org Name:REFLECTIONS RECOVERY AND LEARNING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-581-5556
Mailing Address - Street 1:8907 GRAVELLY LAKE DR SW STE D
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8907 GRAVELLY LAKE DR SW STE D
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3152
Practice Address - Country:US
Practice Address - Phone:253-581-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27036400251S00000X
WA27124700251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1993989Medicaid
WA1992510Medicaid