| Formations Behavior Therapy | |
|
1313 Ne 134th St Ste 110 Vancouver WA 98685 | |
| (360) 518-6249 | |
| Not Available |
| Full Name | Formations Behavior Therapy |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1313 Ne 134th St Ste 110, Vancouver, Washington |
| Authorized Official Name and Position | Ellis Grant Thompson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2068541829 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Formations Behavior Therapy 5502 Ne 74th Ave Vancouver WA 98662-6386 Ph: (360) 518-6249 | Formations Behavior Therapy 1313 Ne 134th St Ste 110 Vancouver WA 98685 Ph: (360) 518-6249 |
| NPI Number | 1326546235 |
|---|---|
| Provider Enumeration Date | 01/25/2018 |
| Last Update Date | 06/03/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326546235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 604176297 (Washington) | Primary |
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