Provider Demographics
NPI:1639300130
Name:CLARK COUNTY, WA
Entity Type:Organization
Organization Name:CLARK COUNTY, WA
Other - Org Name:CLARK COUNTY MENTAL HEALTH COURT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL SUPPORT NETWORK ADMINISTRA
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOM-CHHING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-397-2130
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-5000
Mailing Address - Country:US
Mailing Address - Phone:360-397-2130
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:SUITE C-214
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-397-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health