Organization
EASTSIDE THERAPY SERVICES
Active
Other names
Eastside Behavioral Consulting
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FOWLS (BUSINESS MGR)
(509) 209-3177
Entity
Organization
Contact information
Practice address
317 NW GILMAN BLVD #50, ISSAQUAH, WA 98027
(425) 459-5214
Mailing address
317 NW GILMAN BLVD #50, ISSAQUAH, WA 98027
(206) 799-7831
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
02/02/2019
Last updated
08/09/2022
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