Provider Demographics
NPI:1811079049
Name:NORTHWEST PSYCHOLOGICAL RESOURCES LLC
Entity type:Organization
Organization Name:NORTHWEST PSYCHOLOGICAL RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-414-8600
Mailing Address - Street 1:945 11TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2555
Mailing Address - Country:US
Mailing Address - Phone:360-414-8600
Mailing Address - Fax:360-636-7372
Practice Address - Street 1:945 11TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2555
Practice Address - Country:US
Practice Address - Phone:360-414-8600
Practice Address - Fax:360-636-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC49825101Y00000X
WALH4032101Y00000X
WAPY2237103T00000X
WAPY2966103T00000X
WAPY3397103T00000X
WAPY436103T00000X
WAPY3263103T00000X
WAPY2721103T00000X
WAPY1687103T00000X
WAPY2823103T00000X
WAPY1269103T00000X
WALW44741041C0700X
WASW400022611041C0700X
WAPY1656103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0126624OtherLABOR AND INDUSTRIES
WA112359OtherKAISER
WA0126624OtherCRIME VICTIMS
WA112359OtherKAISER