Healthcare Provider Details

I. General information

NPI: 1962986117
Provider Name (Legal Business Name): HONEY BEHAVIORAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2018
Last Update Date: 09/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 80TH AVENUE CT E
PUYALLUP WA
98373-7700
US

IV. Provider business mailing address

1002 N. MERIDIAN STE. 100 PMB 272
PUYALLUP WA
98371
US

V. Phone/Fax

Practice location:
  • Phone: 310-940-8853
  • Fax:
Mailing address:
  • Phone: 310-940-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY JAMBA
Title or Position: MEMBER, BEHAVIOR ANALYST
Credential: MA, BCBA, LBA
Phone: 310-940-8853