Basic Information
| Provider Information | |||||||||
| NPI: | 1154705408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALACIOS | ||||||||
| FirstName: | MARCUS | ||||||||
| MiddleName: | GABRIEL | ||||||||
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| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9901 NE 7TH AVE | ||||||||
| Address2: | STE. C-116 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986854523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605712432 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9901 NE 7TH AVE | ||||||||
| Address2: | STE. C-116 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986854523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605712432 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.