Provider Demographics
NPI:1356522569
Name:PRATHER, ROBERT JEFFERSON JR (MSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JEFFERSON
Last Name:PRATHER
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:PRATHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:2402 NE 78TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-5000
Mailing Address - Country:US
Mailing Address - Phone:214-930-3231
Mailing Address - Fax:
Practice Address - Street 1:6926 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7254
Practice Address - Country:US
Practice Address - Phone:360-993-3238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53110101YM0800X
ORL66311041C0700X
WALW000065301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health