Healthcare Provider Details

I. General information

NPI: 1578137857
Provider Name (Legal Business Name): NORTHWEST EMDR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 NE 41ST ST STE 100
VANCOUVER WA
98662-7935
US

IV. Provider business mailing address

7200 NE 41ST ST STE 100
VANCOUVER WA
98662-7935
US

V. Phone/Fax

Practice location:
  • Phone: 360-953-3199
  • Fax: 360-339-5498
Mailing address:
  • Phone: 360-953-3199
  • Fax: 360-339-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: VANESSA GRAFF
Title or Position: OWNER
Credential: LMHC, LPC
Phone: 360-953-3199