Basic Information
| Provider Information | |||||||||
| NPI: | 1760772693 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KOSTIAL | ||||||||
| FirstName: | AMBER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE | ||||||||
| Address2: | DEPT 358 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986839324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607886993 | ||||||||
| FaxNumber: | 3607886995 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 SQUALICUM PARKWAY | ||||||||
| Address2: | BEHAVIORAL HEALTH SERVICES | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607886993 | ||||||||
| FaxNumber: | 3607886995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2011 | ||||||||
| LastUpdateDate: | 07/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD60564652 | WA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.