Healthcare Provider Details

I. General information

NPI: 1942607890
Provider Name (Legal Business Name): VANCOUVER GUIDANCE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 MAIN ST
VANCOUVER WA
98663-2752
US

IV. Provider business mailing address

3112 MAIN ST
VANCOUVER WA
98663-2752
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-2016
  • Fax: 360-694-8990
Mailing address:
  • Phone: 360-694-2016
  • Fax: 360-694-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 00000813
License Number StateWA

VIII. Authorized Official

Name: DR. CHRISTOPHER KIRK JOHNSON
Title or Position: CLINIC DIRECTOR
Credential: PH.D.
Phone: 360-694-2016