Provider Demographics
NPI:1568834703
Name:INTERNAL ACCEPTANCE, PLLC
Entity Type:Organization
Organization Name:INTERNAL ACCEPTANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-970-8778
Mailing Address - Street 1:6322 201ST AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-970-8778
Mailing Address - Fax:844-270-5866
Practice Address - Street 1:60 NW BOISTFORT ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2003
Practice Address - Country:US
Practice Address - Phone:360-349-1544
Practice Address - Fax:844-270-5866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH6061175101YM0800X
WAMC60449144305S00000X
WACO60332418305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service