Provider Demographics
NPI:1619379898
Name:PIVOT POINTE COUNSELING CENTER
Entity Type:Organization
Organization Name:PIVOT POINTE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH COUNSELOR ASSOC
Authorized Official - Prefix:MRS
Authorized Official - First Name:PORTIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-836-4386
Mailing Address - Street 1:11818 SE MILL PLAIN BLVD. SUITE 213
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5091
Mailing Address - Country:US
Mailing Address - Phone:360-836-4386
Mailing Address - Fax:
Practice Address - Street 1:11818 SE MILL PLAIN BLVD. SUITE 213
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5091
Practice Address - Country:US
Practice Address - Phone:360-836-4386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60395991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty