Organization
BEHAVIORAL HEALTH RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC JENSEN (CONTROLLER)
(360) 236-7170
Entity
Organization
Contact information
Practice address
1275 S 2ND AVE SW, TUMWATER, WA 98512-6976
(360) 704-7070
(360) 709-4374
Mailing address
3857 MARTIN WAY E, OLYMPIA, WA 98506-5268
(360) 704-7170
(360) 709-4374
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9640525
—
WA
Enumeration date
08/06/2009
Last updated
12/27/2019
Update your record
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