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Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Other names
The Nooksack Hope Behavorial Health Program
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC R DAVENPORT (GOVERNMENT SERVICE EXEC)
(360) 952-5176
Entity
Organization
Contact information
Practice address
6750 MISSION RD, EVERSON, WA 98247-9749
(360) 966-7704
(360) 966-4225
Mailing address
PO BOX 157, DEMING, WA 98244-0157
(360) 966-7704
(360) 966-4225
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1980911
—
WA
Enumeration date
05/14/2007
Last updated
09/09/2011
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