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General NPI Number Information
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NPI Number | 1124755954
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Entity Type | Individual
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Provider Name | ANDY SONG BCBA
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Gender | Male
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 950 BROADWAY STE 404
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City | TACOMA
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State | WA
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Zip | 98402-4454
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Country | US
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Telephone | 253-970-3771
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N HOWARD ST STE R
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City | SPOKANE
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State | WA
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Zip | 99201-0508
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Country | US
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Telephone | 253-970-3771
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61300145
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA61252101
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | BA61252101
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License Number State | WA
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