Provider Demographics
NPI:1528399672
Name:PALOUSE PSYCHIATRY AND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:PALOUSE PSYCHIATRY AND BEHAVIORAL HEALTH
Other - Org Name:PALOUSE PSYCHIATRY AND BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FEBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-332-6139
Mailing Address - Street 1:840 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5502
Mailing Address - Country:US
Mailing Address - Phone:509-332-6139
Mailing Address - Fax:509-332-6579
Practice Address - Street 1:840 SE BISHOP BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5502
Practice Address - Country:US
Practice Address - Phone:509-339-2394
Practice Address - Fax:509-336-7484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULLMAN REGIONAL HOSPITAL CLINIC NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2084P0800X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8891113OtherMEDICARE PTAN