Organization
MINDSOURCE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINE SHEPPARD (DIRECTOR)
(253) 350-0661
Entity
Organization
Contact information
Practice address
27023 164TH AVE SE, COVINGTON, WA 98042-8241
(253) 639-7146
(253) 639-7145
Mailing address
27023 164TH AVE SE, COVINGTON, WA 98042-8241
(253) 639-7146
(253) 639-7145
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
025
WA
Other
Enumeration date
02/21/2014
Last updated
02/21/2014
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