=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861502031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENVIRONMENTALISTS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 399 H ST STE 5
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98230-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-386-6524
-----------------------------------------------------
Fax | 509-529-4182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 399 H ST STE 5
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98230-4100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-386-6524
-----------------------------------------------------
Fax | 509-529-4182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JAMIE E GAVIN
-----------------------------------------------------
Credential | PHD, MPH
-----------------------------------------------------
Telephone | 509-386-6524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP00004549
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH00004520
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number | LH00004520
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LH00004520
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LH0004520
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------