MEDICARE: RAINIER BIOBEHAVIORAL INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	AP30006338	WA

General Provider Information

NPI Number	:	1821190117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINIER BIOBEHAVIORAL INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	8910 MAIN ST E
Second Line	:	SUITE C
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8988
Country	:	US
Telephone Number	:	253-299-6556
Fax Number	:	253-299-6048

Provider Business Practice Location Address
First Line	:	8910 MAIN ST E
Second Line	:	STE C
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-8988
Country	:	US
Telephone Number	:	253-299-6556
Fax Number	:	253-299-6048

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SCOTT PARIS
Credential	:	ARNP
Telephone Number	:	253-299-6556

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	02/24/2014

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