MEDICARE: SPOKANE BEHAVIORAL HEALTH CARE, INC.

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	32 044800	WA

General Provider Information

NPI Number	:	1164427027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPOKANE BEHAVIORAL HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	104 S FREYA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-4862
Country	:	US
Telephone Number	:	509-534-8713
Fax Number	:	509-534-8746

Provider Business Practice Location Address
First Line	:	104 S FREYA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-4862
Country	:	US
Telephone Number	:	509-534-8713
Fax Number	:	509-534-8746

Authorized Official
Title or Position	:	PRESIDENT/CEO/PSYCHOLOGIST
Name	:	DR. ERIC TECUMSEH SMELTZ
Credential	:	PSY.D.
Telephone Number	:	509-981-9999

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/22/2020

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