Provider Demographics
NPI:1861614950
Name:WCHS THE RENTON CLINIC
Entity type:Organization
Organization Name:WCHS THE RENTON CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HONEYCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:425-687-7082
Mailing Address - Street 1:2838 NE SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3106
Mailing Address - Country:US
Mailing Address - Phone:425-687-7082
Mailing Address - Fax:
Practice Address - Street 1:2838 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3106
Practice Address - Country:US
Practice Address - Phone:425-687-7082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001870251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management