Provider Demographics
NPI:1447953294
Name:CHILD, MARRIAGE AND FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:CHILD, MARRIAGE AND FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LODER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-991-4339
Mailing Address - Street 1:12601 S THUNDER MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-9600
Mailing Address - Country:US
Mailing Address - Phone:509-991-4339
Mailing Address - Fax:
Practice Address - Street 1:200 N MULLAN RD STE 214
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3793
Practice Address - Country:US
Practice Address - Phone:509-991-4339
Practice Address - Fax:509-474-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty