Basic Information
| Provider Information | |||||||||
| NPI: | 1003887340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHATCOM COUNSELING & PSYCHIATRIC CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3645 E MCLEOD RD | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762220 | ||||||||
| FaxNumber: | 3606767750 | ||||||||
| Practice Location | |||||||||
| Address1: | 3645 E MCLEOD RD | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762220 | ||||||||
| FaxNumber: | 3606767750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | MARKS | ||||||||
| AuthorizedOfficialFirstName: | MARCY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES GENERALIST | ||||||||
| AuthorizedOfficialTelephone: | 3607524543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 251S00000X | 600469546 | WA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7070543 | 05 | WA | MEDICAID |