Healthcare Provider Details

I. General information

NPI: 1922309467
Provider Name (Legal Business Name): U.S. DEPARTMENT OF VETERAN AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HOLIDAY DR
WHITE RIVER JUNCTION VT
05001-2043
US

IV. Provider business mailing address

11337 SW IRONWOOD LOOP
TIGARD OR
97223-4200
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-2908
  • Fax:
Mailing address:
  • Phone: 503-521-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberRC00049914
License Number StateWA

VIII. Authorized Official

Name: DR. BRENDA EASTMAN
Title or Position: TEAM LEADER
Credential: PSYCHOLOGIST
Phone: 802-295-2908