Organization
BAYSIDE AUTISM THERAPIES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA R TARVER BCBA, SLP (OWNER)
(425) 429-4793
Entity
Organization
Contact information
Practice address
1104 DONOVAN AVE, BELLINGHAM, WA 98225-7325
(425) 429-4793
Mailing address
1104 DONOVAN AVE, BELLINGHAM, WA 98225-7325
(425) 429-4793
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
11520651
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2065537
—
WA
Enumeration date
04/17/2017
Last updated
04/17/2017
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