Provider Demographics
NPI:1093053803
Name:OLYMPIA CENTER FOR DBT, LLC
Entity Type:Organization
Organization Name:OLYMPIA CENTER FOR DBT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:360-294-0994
Mailing Address - Street 1:924 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1548
Mailing Address - Country:US
Mailing Address - Phone:360-338-0363
Mailing Address - Fax:360-753-4308
Practice Address - Street 1:924 7TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1548
Practice Address - Country:US
Practice Address - Phone:360-338-0363
Practice Address - Fax:360-753-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty