Organization
FORMATIONS BEHAVIOR THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIS GRANT THOMPSON (EXECUTIVE DIRECTOR)
(360) 718-8376
Entity
Organization
Contact information
Practice address
6409 E MILL PLAIN BLVD, VANCOUVER, WA 98661-7454
(360) 718-8376
(833) 972-1949
Mailing address
9700 NE 21ST PL, VANCOUVER, WA 98665-5730
(360) 518-6249
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
604176297
WA
Other
Enumeration date
01/25/2018
Last updated
03/11/2025
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