Provider Demographics
NPI:1245507664
Name:KORSGAARD MENTAL HEALTH, INC
Entity type:Organization
Organization Name:KORSGAARD MENTAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KORSGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-389-5794
Mailing Address - Street 1:140 S ARTHUR ST
Mailing Address - Street 2:STE 670
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-389-5794
Mailing Address - Fax:509-533-9627
Practice Address - Street 1:140 S 140 ARTHUR ST
Practice Address - Street 2:STE 415
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2220
Practice Address - Country:US
Practice Address - Phone:509-389-5794
Practice Address - Fax:509-533-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007598363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20000528Medicaid
WA20000528Medicaid