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General NPI Number Information
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NPI Number | 1336527126
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Entity Type | Organization
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Legal Business Name | NORTHWEST TREATMENT SERVICES INC.
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 2614 FORT VANCOUVER WAY SUITE D
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City | VANCOUVER
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State | WA
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Zip | 98661-3971
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Country | US
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Telephone | 360-696-4895
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 FORT VANCOUVER WAY SUITE D
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City | VANCOUVER
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State | WA
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Zip | 98661-3971
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Country | US
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Telephone | 360-696-4895
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PATRICK JAMES CONNELL
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Credential | M.S., L.P.C.
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Telephone | 360-696-4895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C0662
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License Number State | OR
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