Provider Demographics
NPI:1386129906
Name:SPENCER, DEVIN SETH
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:SETH
Last Name:SPENCER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4902
Mailing Address - Country:US
Mailing Address - Phone:360-621-1439
Mailing Address - Fax:
Practice Address - Street 1:1306 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4902
Practice Address - Country:US
Practice Address - Phone:360-997-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WABA61553853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPENDINGMedicaid
WABA61553853OtherWASHINGTON DEPARTMENT OF HEALTH