Provider Demographics
NPI:1538521877
Name:VANCOUVER EMDR THERAPY, PLLC
Entity type:Organization
Organization Name:VANCOUVER EMDR THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEMECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-521-4500
Mailing Address - Street 1:6108 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8751
Mailing Address - Country:US
Mailing Address - Phone:360-521-4500
Mailing Address - Fax:
Practice Address - Street 1:6108 NE HIGHWAY 99
Practice Address - Street 2:SUITE 104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8751
Practice Address - Country:US
Practice Address - Phone:360-521-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000089441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty