1609206291 NPI number — PACIFIC NORTHWEST BEHAVIORAL HEALTH, LLC

Table of content: REBECCA ANNE PERRY CNP (NPI 1396225793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609206291 NPI number — PACIFIC NORTHWEST BEHAVIORAL HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC NORTHWEST BEHAVIORAL HEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609206291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6519 SE MILWAUKIE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-258-2120
Provider Business Mailing Address Fax Number:
971-200-2719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6519 SE MILWAUKIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97202-5519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-258-2120
Provider Business Practice Location Address Fax Number:
971-200-2719
Provider Enumeration Date:
11/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GULLION
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
971-258-2120

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  C2054 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0808X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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