MEDICARE: SEATTLE'S UNION GOSPEL MISSION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	106H00000X	Marriage & Family Therapist
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1447943840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEATTLE'S UNION GOSPEL MISSION

Provider Business Mailing Address
First Line	:	3800 S OTHELLO ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3562
Country	:	US
Telephone Number	:	206-432-8412
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 S OTHELLO ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3562
Country	:	US
Telephone Number	:	206-432-8412
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, BEHAVIORAL HEALTH
Name	:	MISS KRISTIANN DANIELLE SMITH
Credential	:	LMFT
Telephone Number	:	737-276-9633

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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Directions to “SEATTLE'S UNION GOSPEL MISSION ” Practice Location

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