Individual
DESIRAE BEAR EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21 COLVILLE ST, NESPELEM, WA 99155
(509) 634-2600
Mailing address
PO BOX 150, NESPELEM, WA 99155-0150
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
SC60245109
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1044912
—
WA
Enumeration date
09/01/2016
Last updated
09/01/2016
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