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General NPI Number Information
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NPI Number | 1952063265
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Entity Type | Organization
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Legal Business Name | REAL LIFE COMMUNITY BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1498 SE TECH CENTER PL STE 180
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City | VANCOUVER
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State | WA
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Zip | 98683-5518
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Country | US
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Telephone | 360-200-8670
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Fax | 360-838-0413
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Provider Business Mailing Address
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Address Line | 1498 SE TECH CENTER PL STE 180
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City | VANCOUVER
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State | WA
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Zip | 98683-5518
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Country | US
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Telephone | 360-200-8670
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Fax | 360-838-0413
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | JASON NORRIS
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Credential | MA, LMHC
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Telephone | 360-903-4415
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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 |
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