Doctor Name: | ELIZABETH DETTER |
NPI Number: | 1013328616 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | CG60474930 |
Business Practice Address: | 1014 Main St Vancouver, WA - 986603151 |
Business Phone Number: | 3606951014 |
Business Fax Number: | 3607501374 |
Mailing Address: | 1014 Main St, VANCOUVER |
State: | WA |
Postal Code: | 986603151 |
Phone Number: | 3606951014 |
Fax Number: | 3607501374 |
NPI Enumeration Date: | 05/16/2014 |
NPI Last Update Date: | 05/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CG60474930 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |