Healthcare Provider Details

I. General information

NPI: 1295237717
Provider Name (Legal Business Name): HAYDEN WILLIAM BABBY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD STE 222
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

14204 NE 50TH ST
VANCOUVER WA
98682-6332
US

V. Phone/Fax

Practice location:
  • Phone: 360-550-1745
  • Fax:
Mailing address:
  • Phone: 360-521-9351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: