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General NPI Number Information
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NPI Number | 1710348545
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Entity Type | Individual
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Provider Name | STEVEN TIBBITS PEER COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 1601 E 4TH PLAIN BLVD BULIDING 17 SUITE C106
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City | VANCOUVER
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State | WA
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Zip | 98661-3713
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Country | US
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Telephone | 360-397-8070
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Fax | 360-397-8017
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Provider Business Mailing Address
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Address Line | PO BOX 2489
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City | VANCOUVER
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State | WA
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Zip | 98668-2489
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Country | US
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Telephone | 360-397-8070
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Fax | 360-397-8017
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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 | CG60573046
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License Number State | WA
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