Organization
JO NELL R AMBURGEY, MSW, LICSW
Active
Organization
JO NELL R AMBURGEY, MSW, LICSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JO NELL R AMBURGEY LICSW (MENTAL HEALTH COUNSELOR)
(509) 675-0642
Entity
Organization
Contact information
Practice address
298 S MAIN ST, SUITE L3, COLVILLE, WA 99114-2447
(509) 675-0642
(509) 738-2561
Mailing address
PO BOX 513, KETTLE FALLS, WA 99141-0513
(509) 675-0642
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LW00007912
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AMBURJR513RU
DRIVERS LICENSE
WA
Enumeration date
09/10/2014
Last updated
09/10/2014
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