Healthcare Provider Details

I. General information

NPI: 1104541465
Provider Name (Legal Business Name): BE STILL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 7TH AVE STE 310
SPOKANE WA
99204-2833
US

IV. Provider business mailing address

PO BOX 1098
DALLAS NC
28034-1098
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-5659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NATHAN AINLEY
Title or Position: OWNER
Credential:
Phone: 727-800-2332