Provider Demographics
NPI:1346547064
Name:AL'TA COUNSELING & TESTING L.L.C.
Entity Type:Organization
Organization Name:AL'TA COUNSELING & TESTING L.L.C.
Other - Org Name:AL'TA TESTING LABS L.L.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MATHESON
Authorized Official - Last Name:WEKELL
Authorized Official - Suffix:
Authorized Official - Credentials:CDP, SAP
Authorized Official - Phone:253-473-7586
Mailing Address - Street 1:702 BROADWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3735
Mailing Address - Country:US
Mailing Address - Phone:253-473-7586
Mailing Address - Fax:253-590-0211
Practice Address - Street 1:702 BROADWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3735
Practice Address - Country:US
Practice Address - Phone:253-473-7586
Practice Address - Fax:253-590-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27145100251S00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No291U00000XLaboratoriesClinical Medical Laboratory