| Real Life Community Behavioral Health Pllc | |
|
1498 Se Tech Center Pl Ste 180 Vancouver WA 98683-5518 | |
| (360) 200-8670 | |
| (360) 838-0413 |
| Full Name | Real Life Community Behavioral Health Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1498 Se Tech Center Pl Ste 180, Vancouver, Washington |
| Authorized Official Name and Position | Jason Norris (BUSINESS OWNER) |
| Authorized Official Contact | 3609034415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Real Life Community Behavioral Health Pllc 1498 Se Tech Center Pl Ste 180 Vancouver WA 98683-5518 Ph: (360) 200-8670 | Real Life Community Behavioral Health Pllc 1498 Se Tech Center Pl Ste 180 Vancouver WA 98683-5518 Ph: (360) 200-8670 |
| NPI Number | 1952063265 |
|---|---|
| Provider Enumeration Date | 10/13/2021 |
| Last Update Date | 12/06/2024 |
| Certification Date | 12/06/2024 |
| Medicare PECOS PAC ID | 4688012602 |
|---|---|
| Medicare Enrollment ID | O20240409003958 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952063265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Robert P Lindberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871668442 PECOS PAC ID: 1456682343 Enrollment ID: I20191007003279 |
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