Provider Demographics
NPI:1306184593
Name:SOUTH SOUND BEHAVIOR THERAPY CORP
Entity Type:Organization
Organization Name:SOUTH SOUND BEHAVIOR THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNICA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:360-456-2237
Mailing Address - Street 1:3443 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3091
Mailing Address - Country:US
Mailing Address - Phone:360-456-2237
Mailing Address - Fax:360-456-2231
Practice Address - Street 1:3443 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3091
Practice Address - Country:US
Practice Address - Phone:360-456-2237
Practice Address - Fax:360-456-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health