Provider Demographics
NPI:1871299891
Name:TLC BEHAVIORAL CONSULTING SERVICES
Entity type:Organization
Organization Name:TLC BEHAVIORAL CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:360-210-6168
Mailing Address - Street 1:5809 NE 71ST AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1944
Mailing Address - Country:US
Mailing Address - Phone:360-210-6168
Mailing Address - Fax:360-925-3183
Practice Address - Street 1:5809 NE 71ST AVE # C12
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1936
Practice Address - Country:US
Practice Address - Phone:360-210-6168
Practice Address - Fax:360-925-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty