Provider Demographics
NPI:1033755244
Name:WILLAPA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:WILLAPA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SUPPORT
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:PRESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-205-5576
Mailing Address - Street 1:2204 PACIFIC AVE. N.
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631
Mailing Address - Country:US
Mailing Address - Phone:360-642-3787
Mailing Address - Fax:
Practice Address - Street 1:2204 PACIFIC AVE. N.
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631
Practice Address - Country:US
Practice Address - Phone:360-642-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty