| Basics Nw Llc | |
|
320 6th Street Raymond WA 98577-0859 | |
| (360) 915-6868 | |
| (360) 547-6470 |
| Full Name | Basics Nw Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 320 6th Street, Raymond, Washington |
| Authorized Official Name and Position | Matthew Jeffrey Woodard (CEO) |
| Authorized Official Contact | 3602804414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Basics Nw Llc P.o. Box 859 Raymond WA 98577-0859 Ph: (360) 915-6868 | Basics Nw Llc 320 6th Street Raymond WA 98577-0859 Ph: (360) 915-6868 |
| NPI Number | 1073864849 |
|---|---|
| Provider Enumeration Date | 09/20/2012 |
| Last Update Date | 08/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073864849 | NPI | - | NPPES |
| 2029980 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | CL60302030 (Washington) | Secondary |