Provider Demographics
NPI:1942503644
Name:AT PARR OUTPATIENT SERVICES, LLC
Entity Type:Organization
Organization Name:AT PARR OUTPATIENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:NCACI, CCDCIII, CDP
Authorized Official - Phone:509-325-0777
Mailing Address - Street 1:1717 W NORTHWEST BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-3601
Mailing Address - Country:US
Mailing Address - Phone:509-325-0777
Mailing Address - Fax:509-325-3464
Practice Address - Street 1:1717 W NORTHWEST BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-3601
Practice Address - Country:US
Practice Address - Phone:509-325-0777
Practice Address - Fax:509-325-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002447101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty