Healthcare Provider Details

I. General information

NPI: 1164427027
Provider Name (Legal Business Name): SPOKANE BEHAVIORAL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST
SPOKANE WA
99202-4862
US

IV. Provider business mailing address

104 S FREYA ST
SPOKANE WA
99202-4862
US

V. Phone/Fax

Practice location:
  • Phone: 509-534-8713
  • Fax: 509-534-8746
Mailing address:
  • Phone: 509-534-8713
  • Fax: 509-534-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number32 044800
License Number StateWA

VIII. Authorized Official

Name: DR. ERIC TECUMSEH SMELTZ
Title or Position: PRESIDENT/CEO/PSYCHOLOGIST
Credential: PSY.D.
Phone: 509-981-9999