Organization
BASICS NORTHWEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J WOODARD MED BCBA (EXECUTIVE DIRECTOR)
(360) 915-6868
Entity
Organization
Contact information
Practice address
8282 28TH CT NE, SUITE A, LACEY, WA 98516-7162
(360) 915-6868
Mailing address
8282 28TH CT NE, SUITE A, LACEY, WA 98516-7162
(360) 915-6868
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103K00000X
—
WA
Enumeration date
08/23/2013
Last updated
08/23/2013
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