Provider Demographics
NPI:1376387589
Name:NORTHWEST CREDIBLE MESSENGER HEALING TO HOPE LLC
Entity type:Organization
Organization Name:NORTHWEST CREDIBLE MESSENGER HEALING TO HOPE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:206-261-2410
Mailing Address - Street 1:500 S 336TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6389
Mailing Address - Country:US
Mailing Address - Phone:206-261-2410
Mailing Address - Fax:
Practice Address - Street 1:500 S 336TH ST STE 102
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6389
Practice Address - Country:US
Practice Address - Phone:206-261-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health