Provider Demographics
NPI:1730531765
Name:GALVAN, ELI TITO II (LMHC)
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:TITO
Last Name:GALVAN
Suffix:II
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17101 SE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3465
Mailing Address - Country:US
Mailing Address - Phone:228-224-7603
Mailing Address - Fax:
Practice Address - Street 1:2005 SE 192ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7475
Practice Address - Country:US
Practice Address - Phone:360-217-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 102L00000X
WALH60918078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60918078OtherLICENSE NUMBER