Healthcare Provider Details

I. General information

NPI: 1891152831
Provider Name (Legal Business Name): EATING RECOVERY CENTER OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 114TH AVE SE SUITE 180
BELLEVUE WA
98004-6950
US

IV. Provider business mailing address

1601 114TH AVE SE APT 3
BELLEVUE WA
98004-6950
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-1134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLH 60546224
License Number StateWA

VIII. Authorized Official

Name: MS. JESSIE MCGRATH
Title or Position: PRIMARY THERAPIST
Credential: LMHC
Phone: 206-446-5445