Provider Demographics
NPI:1699974113
Name:PALOUSE COUNSELING SERVICE, PLLC
Entity type:Organization
Organization Name:PALOUSE COUNSELING SERVICE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIKKENEN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-527-8451
Mailing Address - Street 1:120 E BIRCH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3054
Mailing Address - Country:US
Mailing Address - Phone:509-527-8451
Mailing Address - Fax:509-527-0942
Practice Address - Street 1:120 E BIRCH ST STE 9
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-527-8451
Practice Address - Fax:509-527-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000085201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB22457OtherGROUP PIN
WA8859583Medicare PIN