Integrative Therapies Walla Walla, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

INTEGRATIVE THERAPIES WALLA WALLA, LLC

Practice address

19 E Birch St Ste 104
Walla Walla, WA 99362-3205

Phone

(773) 349-6778

NPI assigned

Feb 7, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elise Oconnell, LICSWNPI 1548592009

Title

Owner

Phone

(773) 349-6778

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, CO2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elise Oconnell, LICSW

  • Clinical Social Worker
  • Lakewood, CO
  • NPI 1548592009

  WA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1609331206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 E BIRCH ST STE 104",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623205",
            "telephone_number": "773-349-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 E BIRCH ST STE 104",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623205",
            "telephone_number": "773-349-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE THERAPIES WALLA WALLA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-07",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "OCONNELL",
        "authorized_official_first_name": "ELISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-349-6778",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Traci Irving
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• Kenneth H Z Isaacs, MD
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• Clinical Social Worker in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.