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10201 Ne Fourth Plain Road Vancouver WA 98662 | |
| (360) 253-4036 | |
| (360) 253-9794 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 10201 Ne Fourth Plain Road, Vancouver, Washington |
| Authorized Official Name and Position | William R. Waters (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3602534036 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10201 Ne Fourth Plain Road Vancouver WA 98662 Ph: (360) 253-4036 | 10201 Ne Fourth Plain Road Vancouver WA 98662 Ph: (360) 253-4036 |
| NPI Number | 1487888491 |
|---|---|
| Provider Enumeration Date | 05/05/2009 |
| Last Update Date | 05/05/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487888491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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