Provider Demographics
NPI:1356733901
Name:WESTSIDE BEHAVIOR THERAPY, LLC.
Entity type:Organization
Organization Name:WESTSIDE BEHAVIOR THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:503-747-2587
Mailing Address - Street 1:1800 NW 169TH PL STE C100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7362
Mailing Address - Country:US
Mailing Address - Phone:503-747-2587
Mailing Address - Fax:503-746-6323
Practice Address - Street 1:1800 NW 169TH PL STE C100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7362
Practice Address - Country:US
Practice Address - Phone:503-747-2587
Practice Address - Fax:503-746-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10168550103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500709065Medicaid