Provider Demographics
NPI:1578890760
Name:KLALLAM COUNSELING SERVICES
Entity Type:Organization
Organization Name:KLALLAM COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-452-4432
Mailing Address - Street 1:1026 E 1ST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4020
Mailing Address - Country:US
Mailing Address - Phone:360-452-4432
Mailing Address - Fax:360-452-4599
Practice Address - Street 1:1026 E 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4020
Practice Address - Country:US
Practice Address - Phone:360-452-4432
Practice Address - Fax:360-452-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management