Healthcare Provider Details

I. General information

NPI: 1619254729
Provider Name (Legal Business Name): THERAPUETIC HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24823 PACIFIC HWY S STE 103
KENT WA
98032-5478
US

IV. Provider business mailing address

5802 RAINIER AVE S
SEATTLE WA
98118-2706
US

V. Phone/Fax

Practice location:
  • Phone: 253-681-0010
  • Fax: 253-681-0014
Mailing address:
  • Phone: 206-723-1980
  • Fax: 206-721-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEAN POTTER
Title or Position: BILLING MANAGER
Credential:
Phone: 206-323-0930