Provider Demographics
NPI:1932471653
Name:NORTHEAST WASHINGTON FAMILY COUNSELING, P.S.
Entity Type:Organization
Organization Name:NORTHEAST WASHINGTON FAMILY COUNSELING, P.S.
Other - Org Name:NEW FAMILY COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-684-3200
Mailing Address - Street 1:358 E. BIRCH
Mailing Address - Street 2:101
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2762
Mailing Address - Country:US
Mailing Address - Phone:509-684-3200
Mailing Address - Fax:509-684-1908
Practice Address - Street 1:358 E BIRCH AVE
Practice Address - Street 2:101
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2762
Practice Address - Country:US
Practice Address - Phone:509-684-3200
Practice Address - Fax:509-684-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1026103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty