Provider Demographics
NPI:1326247438
Name:NEUROBEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NEUROBEHAVIORAL HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-352-4602
Mailing Address - Street 1:2118 CATON WAY SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1105
Mailing Address - Country:US
Mailing Address - Phone:360-352-4602
Mailing Address - Fax:360-352-3289
Practice Address - Street 1:2118 CATON WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1105
Practice Address - Country:US
Practice Address - Phone:360-352-4602
Practice Address - Fax:360-352-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8868633Medicare UPIN