Healthcare Provider Details

I. General information

NPI: 1487016077
Provider Name (Legal Business Name): CHRIS WEBBERLEY M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2200
  • Fax: 360-567-2212
Mailing address:
  • Phone: 360-619-2226
  • Fax: 360-326-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH61040548
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61040548
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: