Provider Demographics
NPI:1558841361
Name:PACIFIC COUNSELING SERVICES
Entity Type:Organization
Organization Name:PACIFIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHARME-BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-931-0937
Mailing Address - Street 1:1801 1ST AVE STE 2B6
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3270
Mailing Address - Country:US
Mailing Address - Phone:360-931-0937
Mailing Address - Fax:360-353-3232
Practice Address - Street 1:1801 1ST AVE STE 2B6
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3270
Practice Address - Country:US
Practice Address - Phone:360-931-0937
Practice Address - Fax:360-353-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60149240251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2102397Medicaid