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CHILD & ADOLESCENT CLINIC, P.S.

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Company Details

Legal Name: CHILD & ADOLESCENT CLINIC, P.S.
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL SERVICE CORPORATION
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: February 27th 1981
Expiration date: 28 Feb 2026
UBI Number: 600 398 123
ZIP code: 98632
City: Longview
County: COWLITZ
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 971 11TH AVE, LONGVIEW, WA, 98632-2503, UNITED STATES
Supporting healthcare providers fighting with COVID-19: $1,374,460

Contact Details

E-Mail: CPEDERSEN@CANDAC.COM
Phone Number: +1 360-577-1771

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
CHELSAY PEDERSEN Registered Agent 971 11TH AVE, LONGVIEW, WA, 98632-2503, UNITED STATES

Key Officers & Management

Name Role Address
TSERING LHEWA Governing Person 971 - 11TH AVENUE, LONGVIEW, WA, 98632, UNITED STATES
REBECCA HUTFILZ Governing Person 971 - 11TH AVE, LONGVIEW, WA, 98632, UNITED STATES
ANNE SMEENK Governing Person 971 - 11TH AVE, LONGVIEW, WA, 98632, UNITED STATES
WES HENRICKSEN Governing Person -
AMRITA STARK Governing Person -
MARY ALICE MCCUBBINS Governing Person -
JENNIFER CHU-SMITH Governing Person -
KENNETH WU, MD Governing Person 971 - 11TH AVE, LONGVIEW, WA, 98632, UNITED STATES
RANDY COPELAND Governing Person 971 - 11TH AVE, LONGVIEW, WA, 98632, UNITED STATES

National Provider Identifier

NPI Number:
1144275777

Authorized Person:

Name:
DR. PHYLLIS CAVENS
Role:
PHYSICIAN/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
208000000X - Pediatrics Physician
Is Primary:
Yes

Contacts:

Fax:
3604231405
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