Organization
NORTHWEST CHILD AND FAMILY CLINIC, P.C.
Active
Organization
NORTHWEST CHILD AND FAMILY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARON BAST GAVORA PSY.D. (PRESIDENT)
(503) 636-4333
Entity
Organization
Contact information
Practice address
14619 NE 82ND AVE, VANCOUVER, WA 98662-1057
(503) 636-4333
Mailing address
14619 NE 82ND AVE, VANCOUVER, WA 98662-1057
(503) 636-4333
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1373
OR
103TC0700X
Clinical Psychologist
Primary
TE00003919
WA
Other
Enumeration date
04/03/2007
Last updated
03/07/2008
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