Organization
WILD HEART SOCIETY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE DUNHAM LCSW (PARTNER/THERAPIST)
(360) 521-3055
Entity
Organization
Contact information
Practice address
15604 NE 28TH AVE, VANCOUVER, WA 98686-1541
(360) 521-3055
Mailing address
15604 NE 28TH AVE, VANCOUVER, WA 98686-1541
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2019
Last updated
03/04/2019
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