Provider Demographics
NPI:1427115765
Name:NORTHWEST NEUROBEHAVIORAL INSTITUTE
Entity type:Organization
Organization Name:NORTHWEST NEUROBEHAVIORAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:RICHELLE
Authorized Official - Last Name:GUZZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-456-3600
Mailing Address - Street 1:1303 N DIVISION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1930
Mailing Address - Country:US
Mailing Address - Phone:509-456-3600
Mailing Address - Fax:509-747-4420
Practice Address - Street 1:1303 N DIVISION ST
Practice Address - Street 2:SUITE A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1930
Practice Address - Country:US
Practice Address - Phone:509-456-3600
Practice Address - Fax:509-747-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002557103G00000X
WAPY00003323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8857391Medicare PIN