Basic Information
| Provider Information | |||||||||
| NPI: | 1730682634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINCK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | HERMAN | ||||||||
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| Credential: | LMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 461 | ||||||||
| Address2: | |||||||||
| City: | NEAH BAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983570461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606405291 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 WELLNESS WAY | ||||||||
| Address2: | PO BOX 414 | ||||||||
| City: | NEAH BASY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606452233 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2018 | ||||||||
| LastUpdateDate: | 03/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC60791161 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.