Basic Information
| Provider Information | |||||||||
| NPI: | 1811123631 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BENTON/FRANKLIN COUNTY CRISIS RESPONSE UNIT | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2635 W DESCHUTES AVE | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993363004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097830500 | ||||||||
| FaxNumber: | 5097839129 | ||||||||
| Practice Location | |||||||||
| Address1: | 2635 W DESCHUTES AVE | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993363004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097830500 | ||||||||
| FaxNumber: | 5097839129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 06/08/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CABLE | ||||||||
| AuthorizedOfficialFirstName: | GORDON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5097830500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.S.,DMHP,LMHC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 020701RC00033141 | WA | Y | Agencies | Community/Behavioral Health |
No ID Information.