Healthcare Provider Details

I. General information

NPI: 1649461740
Provider Name (Legal Business Name): CENTER FOR ASSESSMENT & THERAPY SERVICES PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10634 E RIVERSIDE DR SUITE 130
BOTHELL WA
98011-3757
US

IV. Provider business mailing address

10634 E RIVERSIDE DR SUITE 130
BOTHELL WA
98011-3757
US

V. Phone/Fax

Practice location:
  • Phone: 425-533-5487
  • Fax:
Mailing address:
  • Phone: 425-533-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA LYN PETERSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 425-533-5487