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General NPI Number Information
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NPI Number | 1104439686
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Entity Type | Individual
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Provider Name | GEOFFREY SEVERIN WAMPACH BS
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Gender | Male
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1313 NE 134TH ST STE 220A
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City | VANCOUVER
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State | WA
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Zip | 98685-2722
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Country | US
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Telephone | 360-356-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 2919 NE 116TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98682-8720
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 61584335
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License Number State | WA
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