Provider Demographics
NPI:1396247912
Name:VANCOUVER CLINICAL SERVICES PC
Entity type:Organization
Organization Name:VANCOUVER CLINICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW,LICSW
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-695-7588
Mailing Address - Street 1:2114 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2674
Mailing Address - Country:US
Mailing Address - Phone:360-695-7588
Mailing Address - Fax:360-695-2982
Practice Address - Street 1:3305 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2251
Practice Address - Country:US
Practice Address - Phone:360-695-7588
Practice Address - Fax:360-695-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11662866OtherCAQH#