Basic Information
| Provider Information | |||||||||
| NPI: | 1548936297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMHOLT | ||||||||
| FirstName: | CYBIL | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | SUDPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 844 W CLIFF DR APT 201 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992043752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092167605 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3400 W GARLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992052119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093257232 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.