Provider Demographics
NPI:1316515836
Name:LOURDES CULLUM HOUSE
Entity type:Organization
Organization Name:LOURDES CULLUM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSWA, DCR
Authorized Official - Phone:509-943-9104
Mailing Address - Street 1:404 NEWCOMER ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2242
Mailing Address - Country:US
Mailing Address - Phone:509-952-0312
Mailing Address - Fax:
Practice Address - Street 1:208 CULLUM AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4534
Practice Address - Country:US
Practice Address - Phone:509-946-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty