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General NPI Number Information
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NPI Number | 1396247912
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Entity Type | Organization
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Legal Business Name | VANCOUVER CLINICAL SERVICES PC
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 3305 MAIN ST STE 306
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City | VANCOUVER
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State | WA
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Zip | 98663-2251
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Country | US
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Telephone | 360-695-7588
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Fax | 360-695-2982
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Provider Business Mailing Address
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Address Line | 2114 MAIN ST STE 100
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City | VANCOUVER
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State | WA
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Zip | 98660-2674
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Country | US
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Telephone | 360-695-7588
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Fax | 360-695-2982
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Authorized Official
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Title or Position | MSW,LICSW
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Name | JEANNETTE BATEMAN
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Credential |
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Telephone | 360-695-7588
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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 |
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License Number State | WA
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