Provider Demographics
NPI:1720785660
Name:CHILDRENS MENTAL HEALTH AND PARENTING SUPPORT PLLC
Entity Type:Organization
Organization Name:CHILDRENS MENTAL HEALTH AND PARENTING SUPPORT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:360-784-0559
Mailing Address - Street 1:6715 NE 63RD ST STE 103-268
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1980
Mailing Address - Country:US
Mailing Address - Phone:360-784-0559
Mailing Address - Fax:
Practice Address - Street 1:6715 NE 63RD ST STE 103-268
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1980
Practice Address - Country:US
Practice Address - Phone:360-784-0559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty