Provider Demographics
NPI:1790407641
Name:BEHAVIOR SPECIALISTS OF WASHINGTON
Entity Type:Organization
Organization Name:BEHAVIOR SPECIALISTS OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:310-770-3976
Mailing Address - Street 1:1524 232ND PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9150
Mailing Address - Country:US
Mailing Address - Phone:310-770-3976
Mailing Address - Fax:
Practice Address - Street 1:1524 232ND PL SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9150
Practice Address - Country:US
Practice Address - Phone:310-770-3976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health