Provider Demographics
NPI:1962271239
Name:COLUMBIA BASIN FAMILY THERAPY, LLC
Entity type:Organization
Organization Name:COLUMBIA BASIN FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:INFANTE-CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:509-845-6270
Mailing Address - Street 1:100 WALLA WALLA AVE
Mailing Address - Street 2:
Mailing Address - City:ELTOPIA
Mailing Address - State:WA
Mailing Address - Zip Code:99330-9611
Mailing Address - Country:US
Mailing Address - Phone:509-845-6270
Mailing Address - Fax:
Practice Address - Street 1:1619 W OCTAVE ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4045
Practice Address - Country:US
Practice Address - Phone:509-845-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)