Provider Demographics
NPI:1548460025
Name:CENTRAL WASHINGTON UNIVERSITY STUDENT HEALTH COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:CENTRAL WASHINGTON UNIVERSITY STUDENT HEALTH COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-963-1874
Mailing Address - Street 1:400 E. UNIVERSITY WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-7585
Mailing Address - Country:US
Mailing Address - Phone:509-963-1626
Mailing Address - Fax:
Practice Address - Street 1:400 E UNIVERSITY WAY
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-7502
Practice Address - Country:US
Practice Address - Phone:509-963-1626
Practice Address - Fax:509-963-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7001258Medicaid
WA7900871OtherDSHS TAKE CHARGE