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NPI Code Detail

MEDICARE: GREATER LAKES MENTAL HEALTH FOUNDATION INC

MEDICARE: GREATER LAKES MENTAL HEALTH FOUNDATION INC
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 Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3320800000XMental Illness Community Based Residential Treatment Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225039811
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREATER LAKES MENTAL HEALTH FOUNDATION INC
Provider Business Mailing Address
First Line : P.O. BOX 5299
Second Line : MS: 820-5-PCO
City : TACOMA
State : WA
Zip : 98415-0299
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9330 59TH AVE SW
Second Line :
City : LAKEWOOD
State : WA
Zip : 98499-2858
Country : US
Telephone Number : 253-581-7020
Fax Number :
Authorized Official
Title or Position : CEO
Name : WILLIAM GLENN ROBERTSON
Credential :
Telephone Number : 253-403-1272
Provider Enumeration Date : 08/03/2005
Last Update Date : 08/04/2025

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