SOUTH SOUND BEHAVIOR THERAPY CORP (NPI# 1306184593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306184593 |
| Entity Type | Organization |
| Organization Name | SOUTH SOUND BEHAVIOR THERAPY CORP |
| Practice Address |
3443 Lilly Rd Ne Olympia WA 98506-3091 |
| Practice Telephone | 3604562237 |
| Practice Fax Number | 3604562231 |
| Mailing Telephone | 3604562237 |
| Mailing Fax Number | 3604562231 |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | JENNICA KRISTINE WARNER (OWNER) |
| Authorized Official Telephone | 3604562237 |
| Authorized Official Credential | BCBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9333 Martin Way E, Suite 214, Olympia, WA 985165969 | 8082920784 | 3603559089 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | SOUTH SOUND BEHAVIOR THERAPY CORP. | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 |
| Street Address |
3443 LILLY RD NE |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-3091 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285872218 | Jennica Kristine Warner | Behavioral Analyst | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2009-01-29 |
| 1699382952 | Sarah Olivia Dominguez | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-09-30 |
| 1548871361 | Ellie Diane King | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-08-14 |
| 1023628526 | Kaitlin Joyce Agosta | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-08-09 |
| 1053929455 | Emily Marie Benoit | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-07-21 |
| 1811513872 | Morgan Oconnor | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-06-24 |
| 1902437833 | Geena Evana Ortiz | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-01-29 |
| 1811528748 | Ashley Potter | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-01-29 |
| 1720619653 | Garrett Wayne Miller | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-01-29 |
| 1396384731 | Kaiti Brixey | Behavior Technician | 3443 Lilly Rd Ne, Olympia, WA 98506-3091 | 2020-01-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
| Find all providers in zip 98506 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1972992139 | Life Therapeutic Works LLC | Community/Behavioral Health | 3801 S Bay Loop Ne, Olympia, WA 98506-2648 | 2015-01-12 |
| 1831594068 | Behavioral Health Resources | Community/Behavioral Health | 3859 Martin Way E, Olympia, WA 98506-5268 | 2014-10-30 |
| 1124392618 | First Things First 123, LLC | Community/Behavioral Health | 1905 4th Ave. East, Suite B, Olympia, WA 98506 | 2012-02-29 |
| 1568785293 | Catholic Community Services Ww | Community/Behavioral Health | 1202 Black Lake Blvd Sw Ste B, Olympia, WA 98502-7208 | 2010-03-09 |
| 1255571063 | Capital Clubhouse | Community/Behavioral Health | 1000 Cherry St Se, Olympia, WA 98501-1433 | 2009-03-06 |
| 1912561838 | Recovery Innovations, Inc | Community/Behavioral Health | 3432 S Bay Rd Ne, Olympia, WA 98506-2958 | 2019-04-25 |
| 1720589583 | Morningside | Community/Behavioral Health | 809 Legion Way Se, Olympia, WA 98501-1518 | 2018-02-26 |
| 1780195214 | Catholic Community Services | Community/Behavioral Health | 1011 10th Ave Se, Olympia, WA 98501-1566 | 2017-10-24 |
| 1275073926 | Adaptive Living, LLC | Community/Behavioral Health | 805 Carlyon Ave Se, Olympia, WA 98501-3501 | 2017-02-28 |
| Find all providers in OLYMPIA | ||||
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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.