Provider Demographics
NPI:1063281426
Name:MARYCLIFF PSYCHOTHERAPY SERVICES, INC.
Entity type:Organization
Organization Name:MARYCLIFF PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANNE BELLINGHAM
Authorized Official - Last Name:WISENOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:509-455-7654
Mailing Address - Street 1:PO BOX 28271
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99228-8271
Mailing Address - Country:US
Mailing Address - Phone:509-455-7654
Mailing Address - Fax:509-380-9579
Practice Address - Street 1:705 W 7TH AVE STE H2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2836
Practice Address - Country:US
Practice Address - Phone:509-455-7654
Practice Address - Fax:509-380-9579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)