BROTHERHOOD OF THE BROKEN (NPI# 1356847008) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356847008 |
| Entity Type | Organization |
| Organization Name | BROTHERHOOD OF THE BROKEN |
| Practice Address |
5411 Ne 107th Ave Ste 101 Vancouver WA 98662-6347 |
| Mailing Address |
Po Box 874034 Vancouver WA 98687-4034 |
| Practice Telephone | 3606098535 |
| Mailing Telephone | 3606098535 |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2019-04-08 |
| Authorized Official Name | DANIEL T STEPHENS (PRESIDENT) |
| Authorized Official Telephone | 3606098535 |
| Authorized Official Credential | MA, NCC, LMHCA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3400 Se 196th Ave Ste 102, Camas, WA 986078862 | 3606098535 | |
| 5411 Ne 107th Ave Ste 101, Vancouver, WA 986626347 | 3606098535 |
| Street Address |
5411 NE 107TH AVE STE 101 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98662-6347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861024911 | Hillary Ann Devore | Behavior Technician | 9414 Ne Fouth Plain Road, Vancouver, WA 98662 | 2020-02-06 |
| 1073091781 | Jessica Edit Villasenor | Social Worker | 9800 Ne Oakview Dr, Vancouver, WA 98662 | 2018-08-03 |
| 1568991123 | Preferred Rx Pharmacy Inc | Pharmacy | 10303 Ne Fourth Plain Blvd Ste 109, Vancouver, WA 98662 | 2017-06-07 |
| 1982058814 | Nw Interventional Medicine and Orthopedic Rehab Pllc | Physician Assistant | 11802 Ne 65th St., Vancouver, WA 98662 | 2016-04-18 |
| 1942685664 | Silpa Nekkalapudi | Dentist | 11504 Ne 119th St, Suite 100, Vancouver, WA 98662 | 2015-07-23 |
| 1528468261 | Lidiya Chepa | Pharmacist | 14505 Ne Fourth Plain Boulevard, Vancouver, WA 98662 | 2014-08-29 |
| 1962827030 | Vanessa Wulff | Chiropractor | 6405 Ne 116th Ave Ste 106, Vancouver, WA 98662 | 2014-02-26 |
| 1326484080 | Precious Jewel Adult Family Home | Custodial Care Facility | 9707 Ne 115th Ct, Vancouver, WA 98662 | 2013-05-21 |
| 1457698466 | Elise C Jones | Counselor | 4400 Ne 77th Ave., Suite 275, Vancouver, WA 98662 | 2013-01-10 |
| 1396096103 | At Home Sleep Solutions | Clinic/Center | 9330 Ne Vancouver Mall Dr., Suite 202, Vancouver, WA 98662 | 2012-09-20 |
| Find all providers in zip 98662 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366067803 | Darcy Jacquet | Counselor | 7708 Ne 78th St, Vancouver, WA 98662-3603 | 2020-06-10 |
| 1942832381 | Dena M Alt | Counselor | 8000 Ne 139th Ave, Vancouver, WA 98682-3337 | 2020-02-04 |
| 1669019659 | Heather Alexandra Smith | Counselor | 6221 Ne Fourth Plain Blvd, Suite 130, Vancouver, WA 98661-7210 | 2019-12-09 |
| 1790327807 | Ly Khim | Counselor | 1601 E 4th Plain Blvd Bldg 17m, Vancouver, WA 98661-3717 | 2019-10-09 |
| 1922665090 | Lindsey Beth Lapore | Counselor | 6221 Ne Fourth Plain Blvd Apt 120, Vancouver, WA 98661-7210 | 2019-05-23 |
| 1548734148 | Lisa Kelly | Counselor | 1601 E 4th Blvd., Vancouver, WA 98661 | 2019-01-16 |
| 1629549878 | Christine M Kille | Counselor | 4107 Nw Fruit Valley Rd Ste J, Vancouver, WA 98660-1275 | 2018-12-16 |
| 1174047690 | Douglas Gangat Uy | Counselor | 1610 C Street, Suite 102, Vancouver, WA 98663 | 2017-07-26 |
| 1477075091 | Justin Scott Schultz | Counselor | 1601 E 4th Plain Blvd # A212, Vancouver, WA 98661-3713 | 2017-07-14 |
| 1730611823 | Nathan Meeds | Counselor | 11818 Se Mill Plain Blvd Ste 311d, Vancouver, WA 98684-5091 | 2017-03-29 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.