MEDICARE: BEHAVIORAL HEALTH RESOURCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	600255953	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093895203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH RESOURCES

Provider Business Mailing Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:	360-704-7182

Provider Business Practice Location Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:	360-704-7182

Authorized Official
Title or Position	:	CONTROLLER
Name	:	ERIC JENSEN
Credential	:
Telephone Number	:	360-236-7170

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/27/2019

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Directions to “BEHAVIORAL HEALTH RESOURCES ” Practice Location

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