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NPI Code Detail

MEDICARE: FORMATIONS BEHAVIOR THERAPY

MEDICARE: FORMATIONS BEHAVIOR THERAPY
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
1251S00000XCommunity/Behavioral Health Agency604176297WA

General Provider Information

NPI Number : 1326546235
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORMATIONS BEHAVIOR THERAPY
Provider Business Mailing Address
First Line : 9700 NE 21ST PL
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-5730
Country : US
Telephone Number : 360-518-6249
Fax Number :
Provider Business Practice Location Address
First Line : 6409 E MILL PLAIN BLVD
Second Line :
City : VANCOUVER
State : WA
Zip : 98661-7454
Country : US
Telephone Number : 360-718-8376
Fax Number : 833-972-1949
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : ELLIS GRANT THOMPSON
Credential :
Telephone Number : 360-718-8376
Provider Enumeration Date : 01/25/2018
Last Update Date : 03/11/2025

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Directions to “FORMATIONS BEHAVIOR THERAPY ” Practice Location

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