Provider Demographics
NPI:1558481499
Name:A BEHAVIORAL PRACTICE
Entity Type:Organization
Organization Name:A BEHAVIORAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:OKEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-255-2111
Mailing Address - Street 1:1000 MCKENZIE AVE
Mailing Address - Street 2:#25
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7003
Mailing Address - Country:US
Mailing Address - Phone:360-255-2111
Mailing Address - Fax:360-306-3945
Practice Address - Street 1:1000 MCKENZIE AVE
Practice Address - Street 2:#25
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7003
Practice Address - Country:US
Practice Address - Phone:360-255-2111
Practice Address - Fax:306-306-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601805042261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR31850Medicare UPIN
WAG115000224Medicare ID - Type Unspecified