Organization Name: | HEAVENSFIELD GROUP, LLC |
NPI Number: | 1194092130 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | COSETTE D RAE (CLINICAL DIRECTOR) |
Mailing Address: | 1001 290th Ave Se Fall City |
State: | WA US |
Postal Code: | 980247403 |
Phone Number: | 4252223706 |
Fax Number: | 8887883419 |
NPI Enumeration Date: | 11/18/2011 |
NPI Last Update Date: | 11/18/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH00003472 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |