Provider Demographics
NPI:1871170498
Name:KETTLE RIVER WHOLE LIFE, INC.
Entity type:Organization
Organization Name:KETTLE RIVER WHOLE LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-207-0082
Mailing Address - Street 1:21 LOUIE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CURLEW
Mailing Address - State:WA
Mailing Address - Zip Code:99118-9704
Mailing Address - Country:US
Mailing Address - Phone:509-207-0082
Mailing Address - Fax:833-392-1177
Practice Address - Street 1:21 LOUIE CREEK DR
Practice Address - Street 2:
Practice Address - City:CURLEW
Practice Address - State:WA
Practice Address - Zip Code:99118-9704
Practice Address - Country:US
Practice Address - Phone:509-207-0082
Practice Address - Fax:833-392-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty