Provider Demographics
NPI:1417357914
Name:CENTRAL WASHINGTON COMPREHENSIVE MENTAL HEALTH
Entity Type:Organization
Organization Name:CENTRAL WASHINGTON COMPREHENSIVE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTYLYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVEIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCISW
Authorized Official - Phone:509-575-4084
Mailing Address - Street 1:402 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3546
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:
Practice Address - Street 1:402 S. 4TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98907
Practice Address - Country:US
Practice Address - Phone:509-575-4084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6060795251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health