Provider Demographics
NPI:1588130520
Name:BABCOCK, CHRISTOPHER NATHAN (101YA0400X)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:NATHAN
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:101YA0400X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 E RICH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-3159
Mailing Address - Country:US
Mailing Address - Phone:360-789-1284
Mailing Address - Fax:
Practice Address - Street 1:628 E RICH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-3159
Practice Address - Country:US
Practice Address - Phone:360-789-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60689146101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60689146Medicaid