Provider Demographics
NPI:1700025202
Name:NORTHWEST BEHAVIORAL HEALTH CLINIC
Entity Type:Organization
Organization Name:NORTHWEST BEHAVIORAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MABEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-742-3460
Mailing Address - Street 1:905 W RIVERSIDE AVE STE 610
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1099
Mailing Address - Country:US
Mailing Address - Phone:509-742-3460
Mailing Address - Fax:509-742-3461
Practice Address - Street 1:905 W RIVERSIDE AVE STE 610
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1099
Practice Address - Country:US
Practice Address - Phone:509-742-3460
Practice Address - Fax:509-742-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7015662Medicaid