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NPI Code Detail

MEDICARE: CONSEJO COUNSELING AND REFERRAL SERVICE - SOUTH PARK

MEDICARE: CONSEJO COUNSELING AND REFERRAL SERVICE - SOUTH PARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency600287044WA
2251S00000XCommunity/Behavioral Health AgencyWA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3135400OTHERWADBHR SITE LICENSE ID
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083771851
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONSEJO COUNSELING AND REFERRAL SERVICE - SOUTH PARK
Provider Business Mailing Address
First Line : 3808 S ANGELINE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1712
Country : US
Telephone Number : 206-461-4880
Fax Number : 206-461-6989
Provider Business Practice Location Address
First Line : 8615 14TH AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98108-4806
Country : US
Telephone Number : 206-461-4880
Fax Number : 206-762-0489
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MARIO PAREDES
Credential :
Telephone Number : 206-461-4880
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/27/2018

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Directions to “CONSEJO COUNSELING AND REFERRAL SERVICE - SOUTH PARK ” Practice Location

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