Basic Information
| Provider Information | |||||||||
| NPI: | 1043810633 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR BEHAVIORAL HEALTH SOLUTIONS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2164 | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983900480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063872469 | ||||||||
| FaxNumber: | 8776829319 | ||||||||
| Practice Location | |||||||||
| Address1: | 4445 SE FIRMONT DR | ||||||||
| Address2: | |||||||||
| City: | PORT ORCHARD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983679015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605353847 | ||||||||
| FaxNumber: | 8776829319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2020 | ||||||||
| LastUpdateDate: | 11/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | BERRY-REICH | ||||||||
| AuthorizedOfficialFirstName: | KAYLEE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3605353847 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.