Provider Demographics
NPI:1790034627
Name:CLARK COUNTY JUVENILE COURT
Entity Type:Organization
Organization Name:CLARK COUNTY JUVENILE COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JUVENILE COURT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESCAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:360-397-2201
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-5000
Mailing Address - Country:US
Mailing Address - Phone:360-397-2201
Mailing Address - Fax:360-397-2246
Practice Address - Street 1:500 W 11TH STREET
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660
Practice Address - Country:US
Practice Address - Phone:360-397-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001940106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty