Provider Demographics
NPI:1447638853
Name:ISLAND BEHAVIORAL MEDICINE, PS
Entity type:Organization
Organization Name:ISLAND BEHAVIORAL MEDICINE, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:360-682-5016
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-0378
Mailing Address - Country:US
Mailing Address - Phone:360-682-5016
Mailing Address - Fax:360-682-5476
Practice Address - Street 1:3208 K AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221
Practice Address - Country:US
Practice Address - Phone:360-682-5016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60428818101YM0800X
WAPY60620631103T00000X
WALW603954221041C0700X
WALF60125307106H00000X
WAOP602486242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044886Medicaid
WAG8957249OtherMEDICARE PTAN