Provider Demographics
NPI:1235907122
Name:BRAIN BASED THERAPY NW
Entity Type:Organization
Organization Name:BRAIN BASED THERAPY NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROTTY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PSYD
Authorized Official - Phone:509-720-4784
Mailing Address - Street 1:705 W 7TH AVE STE F105W21
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2836
Mailing Address - Country:US
Mailing Address - Phone:509-720-4784
Mailing Address - Fax:509-232-5543
Practice Address - Street 1:705 W 7TH AVE STE F
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2836
Practice Address - Country:US
Practice Address - Phone:150-972-0478
Practice Address - Fax:509-232-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty