Healthcare Provider Details

I. General information

NPI: 1710348545
Provider Name (Legal Business Name): STEVEN TIBBITS PEER COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD BULIDING 17 SUITE C106
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

PO BOX 2489
VANCOUVER WA
98668-2489
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8070
  • Fax: 360-397-8017
Mailing address:
  • Phone: 360-397-8070
  • Fax: 360-397-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60573046
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: