Provider Demographics
NPI:1649447681
Name:OLYMPIC PERSONAL GROWTH CENTER
Entity type:Organization
Organization Name:OLYMPIC PERSONAL GROWTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-681-8463
Mailing Address - Street 1:PO BOX 3175
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5011
Mailing Address - Country:US
Mailing Address - Phone:360-681-8463
Mailing Address - Fax:360-681-8465
Practice Address - Street 1:390 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3403
Practice Address - Country:US
Practice Address - Phone:360-681-8463
Practice Address - Fax:360-681-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0508600251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health