| Divinity Llc | |
|
3957 Garden Spot Rd Loon Lake WA 99148-9750 | |
| (509) 990-9416 | |
| Not Available |
| Full Name | Divinity Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 3957 Garden Spot Rd, Loon Lake, Washington |
| Authorized Official Name and Position | Kristin Kenyon-miller (OWNER) |
| Authorized Official Contact | 5099909416 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divinity Llc Po Box 1037 Loon Lake WA 99148-1037 Ph: (509) 990-9416 | Divinity Llc 3957 Garden Spot Rd Loon Lake WA 99148-9750 Ph: (509) 990-9416 |
| NPI Number | 1013803360 |
|---|---|
| Provider Enumeration Date | 06/14/2025 |
| Last Update Date | 06/14/2025 |
| Certification Date | 06/14/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013803360 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Reflect Behavioral Health Billing Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 41903 Arnold Road, Loon Lake, WA 99148 Phone: 719-290-9547 |