Provider Demographics
NPI:1336657089
Name:WITHINSIGHT MIND & BODY, LLC
Entity Type:Organization
Organization Name:WITHINSIGHT MIND & BODY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KREUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-948-8373
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-0532
Mailing Address - Country:US
Mailing Address - Phone:509-948-8373
Mailing Address - Fax:
Practice Address - Street 1:3902 W CLEARWATER AVE STE 106
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2676
Practice Address - Country:US
Practice Address - Phone:509-948-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60781488251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health