Healthcare Provider Details

I. General information

NPI: 1194341685
Provider Name (Legal Business Name): LAKEVIEW MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 10/31/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 219TH ST SW STE 480
MOUNTLAKE TERRACE WA
98043-2222
US

IV. Provider business mailing address

6100 219TH ST SW STE 480
MOUNTLAKE TERRACE WA
98043-2222
US

V. Phone/Fax

Practice location:
  • Phone: 425-903-8911
  • Fax:
Mailing address:
  • Phone: 425-903-8911
  • Fax: 425-502-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEXANDRA JAMIE PALES
Title or Position: CEO
Credential: ARNP
Phone: 425-903-8911