Organization
JUBILEE LEADERSHIP ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENDALL TODD WAGNER LICSW (CLINICAL DIRECTOR)
(509) 749-2103
Entity
Organization
Contact information
Practice address
29 JUBILEE CIR, PRESCOTT, WA 99348-8607
(509) 749-2103
Mailing address
29 JUBILEE CIR, PRESCOTT, WA 99348-8607
(509) 749-2103
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/16/2015
Last updated
04/17/2015
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