Basic Information
| Provider Information | |||||||||
| NPI: | 1326247438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROBEHAVIORAL HEALTH ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2118 CATON WAY SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603524602 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Practice Location | |||||||||
| Address1: | 2118 CATON WAY SW | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985021105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603524602 | ||||||||
| FaxNumber: | 3603523289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 08/12/2014 | ||||||||
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| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3603524602 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2082 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.