Organization
BLUE MOUNTAIN COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KENNETH ROUGHTON PHD (DIRECTOR)
(509) 382-1164
Entity
Organization
Contact information
Practice address
221 E WASHINGTON AVE, DAYTON, WA 99328-1317
(509) 382-1164
(509) 382-1166
Mailing address
221 E WASHINGTON AVE, DAYTON, WA 99328-1317
(509) 382-1164
(509) 382-1166
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
07 0014 00
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1994995
—
WA
Enumeration date
08/01/2007
Last updated
08/01/2007
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