David Charles Port
Individual provider Active NPI Mental Health Counselor · Pullman, WA
NPI 1376774786 · NPPES record last updated Aug 3, 2009
Key facts
- NPI
- 1376774786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- RC00017858 (WA)
- Practice address
- 340 NE Maple St
Pullman, WA 99163-4120 - Phone
- (509) 334-1133
- Fax
- (509) 332-1608
- NPI assigned
- Aug 3, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC00017858 | WA | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | RC00017858 | WA | Yes |
Addresses
Primary practice location
340 NE Maple St
Pullman, WA 99163-4120
Mailing address
340 NE Maple St
Pullman, WA 99163-4120
Phone (509) 334-1133
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All providers in Pullman, WA · Mental Health Counselor in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.