=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710795059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEY SLUYS
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2024
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1498 SE TECH CENTER PL STE 180
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98683-5518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 867-036-0200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2455 PARK HILL DR
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98632-5785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-936-2118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------