Healthcare Provider Details

I. General information

NPI: 1427258250
Provider Name (Legal Business Name): DIAGNOSTIC & TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 COLE ST
ENUMCLAW WA
98022-3504
US

IV. Provider business mailing address

1818 COLE ST
ENUMCLAW WA
98022-3504
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-9205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY00002405
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CYNTHIA WALTMAN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 360-825-9205