Provider Demographics
NPI:1073661286
Name:BEHAVIORAL MEDICINE NORTHWEST, P.S.
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE NORTHWEST, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:HAY
Authorized Official - Last Name:POWEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-720-6155
Mailing Address - Street 1:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0160
Mailing Address - Country:US
Mailing Address - Phone:206-720-6155
Mailing Address - Fax:360-697-3761
Practice Address - Street 1:345 KNECHTEL WAY NE
Practice Address - Street 2:#111
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2860
Practice Address - Country:US
Practice Address - Phone:206-720-6155
Practice Address - Fax:206-866-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA251056000OtherMAGELLAN HEALTH SERVICES