Provider Demographics
NPI:1336405141
Name:INNOVATION RESOURCE CENTER
Entity Type:Organization
Organization Name:INNOVATION RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:GUERRER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, NCACI, SAP, CDP
Authorized Official - Phone:509-836-2400
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0953
Mailing Address - Country:US
Mailing Address - Phone:509-836-2400
Mailing Address - Fax:509-836-2400
Practice Address - Street 1:214 S 6TH ST
Practice Address - Street 2:UNIT #3
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1446
Practice Address - Country:US
Practice Address - Phone:509-836-2400
Practice Address - Fax:509-836-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty