JOHNATHAN SAMUEL DETWILER (NPI# 1558829457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558829457 |
| Entity Type | Individual |
| Full Name | JOHNATHAN SAMUEL DETWILER |
| Credential | LMHC |
| Practice Address |
5501 Ne 109th Ct Ste A1 Vancouver WA 98662-6173 |
| Mailing Address |
3124 Ne 162nd Ave Portland OR 97230-5524 |
| Practice Telephone | 3605664432 |
| Mailing Telephone | 2603489872 |
| Enumeration Date | 2019-03-10 |
| Last Update Date | 2020-10-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
C5666 | OR | Behavioral Health & Social Service Providers |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
LH61055500 | WA | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
39003508A | IN | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 703 W Park St, Cayuga, IN 479288207 | 7654929042 | 7654929048 |
| Street Address |
5501 NE 109TH CT STE A1 |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98662-6173 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235494477 | Breya Chantarabunchorn | Marriage & Family Therapist | 5501 Ne 109th Ct Ste A1, Vancouver, WA 98662-6173 | 2012-07-12 |
| 1437713864 | Sea Mar Community Health Center | Clinic/Center | 5501 Ne 109th Ct Ste A1, Vancouver, WA 98662-6173 | 2019-05-01 |
| 1134682115 | Sea - Mar Community Health Center | Clinic/Center | 5501 Ne 109th Ct Ste A1, Vancouver, WA 98662-6173 | 2019-04-08 |
| 1780146670 | Maribel Yadira Garza | Case Manager/Care Coordinator | 5501 Ne 109th Ct Ste A1, Vancouver, WA 98662-6173 | 2019-04-01 |
| 1427509017 | Marguerite Mccormack | Counselor | 5501 Ne 109th Ct Ste A1, Vancouver, WA 98662-6173 | 2016-10-18 |
| 1669869442 | Lynette Ramirez | Counselor | 5501 Ne 109th Ct Ste A1, Vancouver, WA 98662-6173 | 2015-04-20 |
| 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 | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508463878 | Andrew Accornero | Counselor | 108 Se 124th Ave Ste 17, Vancouver, WA 98684-6015 | 2020-10-08 |
| 1962024703 | Sarah Elizabeth Wahl | Counselor | 10919 Ne Sherwood Dr, Vancouver, WA 98686-4324 | 2020-05-14 |
| 1922632900 | Jeremy Houtsma Counseling LLC | Counselor | 601 Main St Ste 309, Vancouver, WA 98660-3404 | 2020-02-27 |
| 1194367631 | Ashley Amber Thomas | Counselor | 5732 Ne 131st Pl, Vancouver, WA 98682-2277 | 2019-10-16 |
| 1164073698 | Michelle L Drake | Counselor | 9606 Ne 19th St, Vancouver, WA 98664-2983 | 2019-09-25 |
| 1306496260 | Shaina Lee Heimerl | Counselor | 4317 Ne Thurston Way Ste 11, Vancouver, WA 98662-6658 | 2019-09-12 |
| 1205497013 | Natasha Marie Medina | Counselor | 1104 Main St Ste M105, Vancouver, WA 98660-2969 | 2019-06-23 |
| 1295395267 | Nicola R Cook | Counselor | 6221 Ne Fourth Plain Blvd Apt 130, Vancouver, WA 98661-7210 | 2019-06-20 |
| 1720643851 | Christine Yoshida | Counselor | 10000 Ne 7th Ave # 100-d, Vancouver, WA 98685-4599 | 2019-05-03 |
| 1679035364 | Breanne Alina Valrance | Counselor | 6601 Ne 71st Ave, Vancouver, WA 98661-1945 | 2019-04-02 |
| 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.