Healthcare Provider Details

I. General information

NPI: 1932529120
Provider Name (Legal Business Name): PACIFIC BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 130TH AVE NE STE 104
BELLEVUE WA
98005-1770
US

IV. Provider business mailing address

2370 130TH AVE NE STE 104
BELLEVUE WA
98005-1770
US

V. Phone/Fax

Practice location:
  • Phone: 425-628-2820
  • Fax:
Mailing address:
  • Phone: 425-628-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60450953
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60411510
License Number StateWA

VIII. Authorized Official

Name: DR. JAMES PHILLIP OLSEN
Title or Position: PRESIDENT
Credential: J.D., PH.D., LMHC
Phone: 425-628-2820