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Organization

BLUE MOUNTAIN HEALTH COOPERATIVE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ALAYNA BRINTON LICSW (DIRECTOR)
(509) 840-4618
Entity
Organization

Contact information

Practice address
2330 EASTGATE ST STE 105, WALLA WALLA, WA 99362-1559
(509) 973-5788
Mailing address
2580 CHISHOLM CT, WALLA WALLA, WA 99362-9266
(509) 840-4618
(509) 769-5221

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
104100000X
Social Worker
1041C0700X
Clinical Social Worker
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center
363LP2300X
Primary Care Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2168971
WA
Enumeration date
10/22/2020
Last updated
07/23/2021
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