Provider Demographics
NPI:1205241106
Name:ACTION COUNSELING
Entity type:Organization
Organization Name:ACTION COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:LACK
Authorized Official - Suffix:III
Authorized Official - Credentials:MA, CDP, CL
Authorized Official - Phone:509-735-7410
Mailing Address - Street 1:PO BOX 5697
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0697
Mailing Address - Country:US
Mailing Address - Phone:509-735-7410
Mailing Address - Fax:509-783-5953
Practice Address - Street 1:4911 W CANAL DR
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7755
Practice Address - Country:US
Practice Address - Phone:509-735-7410
Practice Address - Fax:509-783-5953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA03060500251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health