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2428 W Reynolds Ave Centralia WA 98531 | |
| (360) 330-9044 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2428 W Reynolds Ave, Centralia, Washington |
| Authorized Official Name and Position | Pamela Trumble (CREDENTIALING) |
| Authorized Official Contact | 3603309044 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2428 W Reynolds Ave Centralia WA 98531-4554 Ph: (360) 330-9044 | 2428 W Reynolds Ave Centralia WA 98531 Ph: (360) 330-9044 |
| NPI Number | 1619068624 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 07/16/2024 |
| Certification Date | 07/16/2024 |
| Medicare PECOS PAC ID | 5496641177 |
|---|---|
| Medicare Enrollment ID | O20040227000824 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619068624 | NPI | - | NPPES |
| 7035090 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Secondary |
| Provider Name | Roy W Schlegel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942300736 PECOS PAC ID: 6800823816 Enrollment ID: I20050721000376 |
| Provider Name | Jeremy K Greenwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750449013 PECOS PAC ID: 3375702194 Enrollment ID: I20120313000925 |
| Provider Name | Minerva D Arrienda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629071964 PECOS PAC ID: 2567613987 Enrollment ID: I20121113000261 |
| Provider Name | Tracy P Svoboda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861733529 PECOS PAC ID: 6406095843 Enrollment ID: I20141213000344 |
| Provider Name | Cheryl M Mercurio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588085443 PECOS PAC ID: 5799095519 Enrollment ID: I20151106002216 |
| Provider Name | Luke C Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134423056 PECOS PAC ID: 1355586033 Enrollment ID: I20161206001098 |
| Provider Name | Lisa Michelle Archer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043648702 PECOS PAC ID: 0840511960 Enrollment ID: I20191220001486 |
| Provider Name | Teresa J Ekdahl-johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386258697 PECOS PAC ID: 3173934569 Enrollment ID: I20201116000207 |
| Provider Name | Emmanuel M Metayer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609315886 PECOS PAC ID: 4183994452 Enrollment ID: I20210510001875 |
| Provider Name | Angelina Suzanne Campos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104467042 PECOS PAC ID: 5597190710 Enrollment ID: I20210902000824 |
| Provider Name | Traci A Levesque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982061628 PECOS PAC ID: 0648637926 Enrollment ID: I20230531003162 |
| Provider Name | Russell O Funk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1467505636 PECOS PAC ID: 6709239270 Enrollment ID: I20240131003593 |
| Provider Name | Wangari Gathungu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902316086 PECOS PAC ID: 0840626024 Enrollment ID: I20240131004086 |
| Provider Name | Deborah D Ingram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700354099 PECOS PAC ID: 4880047372 Enrollment ID: I20240131004400 |
| Provider Name | Leann J Reed |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1376965475 PECOS PAC ID: 6002269503 Enrollment ID: I20240131004593 |
| Provider Name | Dianna L Padgett |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1720483654 PECOS PAC ID: 2264885763 Enrollment ID: I20240131004634 |
| Provider Name | Duane E Patterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154054344 PECOS PAC ID: 3971956483 Enrollment ID: I20240131004736 |
| Provider Name | Tony J Meinhardt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790265312 PECOS PAC ID: 3274986641 Enrollment ID: I20240201002155 |
| Provider Name | Yasmin Majumder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811305766 PECOS PAC ID: 1254559446 Enrollment ID: I20240506000859 |
| Provider Name | Atilade A Owolabi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629648266 PECOS PAC ID: 0042753204 Enrollment ID: I20240617002811 |
| Provider Name | Nicollette S Mcclanahan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295398956 PECOS PAC ID: 3779026836 Enrollment ID: I20240617003242 |
| Provider Name | Gary L Echols |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922493238 PECOS PAC ID: 3870036981 Enrollment ID: I20240618000891 |
| Provider Name | Breeann Bryson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639731755 PECOS PAC ID: 4284177304 Enrollment ID: I20240618001138 |
| Provider Name | Richard J Stride |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114099223 PECOS PAC ID: 9133298003 Enrollment ID: I20240722004064 |
| Provider Name | Jean C Nikubwayo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093542946 PECOS PAC ID: 1951833581 Enrollment ID: I20241021001152 |
| Provider Name | Ezra J Foss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073877155 PECOS PAC ID: 4385886977 Enrollment ID: I20241105001104 |
Lewis County Therapy Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1000 Kresky Ave # 6, Centralia, WA 98531 Phone: 360-623-5008 | |
Pope's Kids Place Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 230 Washington Way, Centralia, WA 98531 Phone: 360-736-9178 Fax: 360-736-8312 | |
Dynamic Balance Psychology Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1505 Shakespeare Dr, Centralia, WA 98531 Phone: 360-360-5044 | |
South Puget Sound Aba Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 314 River Heights Rd, Centralia, WA 98531 Phone: 360-819-8180 |