Provider Demographics
NPI:1437485679
Name:LANE VAN DER SLUIS INC PS
Entity type:Organization
Organization Name:LANE VAN DER SLUIS INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER SLUIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:360-695-8332
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-0213
Mailing Address - Country:US
Mailing Address - Phone:360-695-8332
Mailing Address - Fax:866-524-1569
Practice Address - Street 1:756 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3845
Practice Address - Country:US
Practice Address - Phone:360-695-8332
Practice Address - Fax:866-524-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001784251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health