Healthcare Provider Details

I. General information

NPI: 1306519319
Provider Name (Legal Business Name): FIRCREST BH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 NE 112TH AVE STE 108
VANCOUVER WA
98684-5115
US

IV. Provider business mailing address

5611 NE 75TH ST
VANCOUVER WA
98661-1053
US

V. Phone/Fax

Practice location:
  • Phone: 949-981-9835
  • Fax:
Mailing address:
  • Phone: 949-981-9835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AYNSLEY BARRIEMORE SILVA
Title or Position: OWNER
Credential:
Phone: 949-981-9835