Healthcare Provider Details

I. General information

NPI: 1689243578
Provider Name (Legal Business Name): 5CODYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16821 SE MCGILLIVRAY BLVD STE 100
VANCOUVER WA
98683-0401
US

IV. Provider business mailing address

16821 SE MCGILLIVRAY BLVD STE 100
VANCOUVER WA
98683-0401
US

V. Phone/Fax

Practice location:
  • Phone: 360-818-9593
  • Fax: 360-828-1001
Mailing address:
  • Phone: 360-818-9593
  • Fax: 360-828-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JEANNE MARIE CODY
Title or Position: CEO
Credential:
Phone: 360-601-2570