Healthcare Provider Details

I. General information

NPI: 1952532996
Provider Name (Legal Business Name): BEHAVIORAL HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S 2ND AVE SW
TUMWATER WA
98512-6976
US

IV. Provider business mailing address

3857 MARTIN WAY E
OLYMPIA WA
98506-5268
US

V. Phone/Fax

Practice location:
  • Phone: 360-704-7070
  • Fax: 360-709-4374
Mailing address:
  • Phone: 360-704-7170
  • Fax: 360-709-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateWA

VIII. Authorized Official

Name: ERIC JENSEN
Title or Position: CONTROLLER
Credential:
Phone: 360-236-7170