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General NPI Number Information
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NPI Number | 1891325551
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Entity Type | Organization
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Legal Business Name | FOUR ELEMENTS BEHAVIORAL HEALTH CORP
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 1104 MAIN ST STE M110
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City | VANCOUVER
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State | WA
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Zip | 98660-2980
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Country | US
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Telephone | 360-695-1075
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Fax | 360-326-1736
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Provider Business Mailing Address
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Address Line | 1104 MAIN ST STE M110
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City | VANCOUVER
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State | WA
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Zip | 98660-2980
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Country | US
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Telephone | 360-695-1075
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Fax | 360-326-1736
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Authorized Official
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Title or Position | BILLING REP
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Name | DONNA GOULDING
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Credential |
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Telephone | 419-565-7298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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