| Adventure Psychological Services, Llc | |
|
717 Ne 61st St #202 Vancouver WA 98665-8753 | |
| (360) 718-6548 | |
| (360) 718-6554 |
| Full Name | Adventure Psychological Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 717 Ne 61st St, Vancouver, Washington |
| Authorized Official Name and Position | Tiffanie Marie Duley (OFFICE MANAGER) |
| Authorized Official Contact | 3607186548 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adventure Psychological Services, Llc 717 Ne 61st St #202 Vancouver WA 98665-8753 Ph: (360) 718-6548 | Adventure Psychological Services, Llc 717 Ne 61st St #202 Vancouver WA 98665-8753 Ph: (360) 718-6548 |
| NPI Number | 1811364227 |
|---|---|
| Provider Enumeration Date | 09/01/2015 |
| Last Update Date | 01/20/2021 |
| Certification Date | 01/20/2021 |
| Medicare PECOS PAC ID | 0345653895 |
|---|---|
| Medicare Enrollment ID | O20201230002602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811364227 | NPI | - | NPPES |
| 2050221 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LH60413305 (Washington) | Primary |
| Provider Name | Beaux Baggesen-jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932337946 PECOS PAC ID: 5395078471 Enrollment ID: I20190604002431 |
| Provider Name | Jamesen Birkel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992327738 PECOS PAC ID: 1456764919 Enrollment ID: I20210706002276 |
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