Provider Demographics
NPI:1104978824
Name:PEND OREILLE COUNTY
Entity type:Organization
Organization Name:PEND OREILLE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LICMSW
Authorized Official - Phone:509-447-5651
Mailing Address - Street 1:PO BOX 5055
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-5055
Mailing Address - Country:US
Mailing Address - Phone:509-447-5651
Mailing Address - Fax:509-447-2671
Practice Address - Street 1:105 SOUTH GARDEN AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-5055
Practice Address - Country:US
Practice Address - Phone:509-447-5651
Practice Address - Fax:509-447-2671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEND OREILLE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-16
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1983907Medicaid
WA1990803Medicaid
WA8807765Medicare ID - Type Unspecified