Organization
COUNSELING SERVICES OF WALLA WALLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTI K BRADLEY MSW ACSW LICSW (OWNER)
(509) 876-0100
Entity
Organization
Contact information
Practice address
127 E ROSE ST, SUITE M, WALLA WALLA, WA 99362-5009
(509) 876-0100
(509) 876-0101
Mailing address
PO BOX 3324, WALLA WALLA, WA 99362-0367
(509) 876-0100
(509) 876-0101
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
LW00006668
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1041C0700X
TAXONOMY
WA
01
—
603-575-701
UBI
WA
01
—
LW00006668
LICSW LICENSE
WA
Enumeration date
02/11/2016
Last updated
02/11/2016
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