Provider Demographics
NPI:1548887383
Name:SWIFTWATER COUNSELING
Entity type:Organization
Organization Name:SWIFTWATER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:509-961-0547
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:NACHES
Mailing Address - State:WA
Mailing Address - Zip Code:98937-0346
Mailing Address - Country:US
Mailing Address - Phone:509-961-0547
Mailing Address - Fax:
Practice Address - Street 1:116 N OAKES AVE STE A2
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1273
Practice Address - Country:US
Practice Address - Phone:509-961-0547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1770863987OtherINDIVIDUAL NPI
WA1548887383Medicaid
WA2163968Medicaid