Provider Demographics
NPI:1174910095
Name:NORTHWEST INSTITUTE FOR INTEGRATIVE COUNSELING AND TRAINING
Entity type:Organization
Organization Name:NORTHWEST INSTITUTE FOR INTEGRATIVE COUNSELING AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ISAMU
Authorized Official - Last Name:MANOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MS MFT, LMFT
Authorized Official - Phone:503-881-0513
Mailing Address - Street 1:355 HIGH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3613
Mailing Address - Country:US
Mailing Address - Phone:503-881-0513
Mailing Address - Fax:
Practice Address - Street 1:355 HIGH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3613
Practice Address - Country:US
Practice Address - Phone:503-881-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0808251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health