Provider Demographics
NPI:1609071588
Name:LA CLINICA NOROESTE DE COMPORTAMIENTOS MODIFICADOS
Entity Type:Organization
Organization Name:LA CLINICA NOROESTE DE COMPORTAMIENTOS MODIFICADOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:509-457-8554
Mailing Address - Street 1:917 PITCHER ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-3063
Mailing Address - Country:US
Mailing Address - Phone:509-457-8554
Mailing Address - Fax:509-225-4682
Practice Address - Street 1:917 PITCHER ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-3063
Practice Address - Country:US
Practice Address - Phone:509-457-8554
Practice Address - Fax:509-225-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39132900261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder