Provider Demographics
NPI:1790831600
Name:SERENITY POINT COUNSELING SERVICES
Entity type:Organization
Organization Name:SERENITY POINT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, CDP
Authorized Official - Phone:509-526-6036
Mailing Address - Street 1:705 W ROSE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1762
Mailing Address - Country:US
Mailing Address - Phone:509-529-6036
Mailing Address - Fax:509-529-6038
Practice Address - Street 1:705 W ROSE ST STE 1
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1762
Practice Address - Country:US
Practice Address - Phone:509-529-6036
Practice Address - Fax:509-529-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4486 SEOtherREGENCE PROVIDER ID
WA1994417Medicaid