Provider Demographics
NPI:1366878332
Name:DAYSPRING BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:DAYSPRING BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-295-7697
Mailing Address - Street 1:1495 NW GILMAN BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5328
Mailing Address - Country:US
Mailing Address - Phone:425-296-7697
Mailing Address - Fax:818-279-2296
Practice Address - Street 1:1495 NW GILMAN BLVD STE 11
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5328
Practice Address - Country:US
Practice Address - Phone:425-296-7697
Practice Address - Fax:818-279-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-22
Last Update Date:2013-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60200909101YA0400X
WALH00010763101YM0800X
WAMC60312903101YM0800X
WA1108103TC0700X
WALH60031142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty