Healthcare Provider Details

I. General information

NPI: 1942770896
Provider Name (Legal Business Name): DORET MONICA GREATHOUSE CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DORET MONICA GREATHOUSE LCM

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 3RD AVE STE 116
SEATTLE WA
98121-2353
US

IV. Provider business mailing address

2133 3RD AVE
SEATTLE WA
98121-2385
US

V. Phone/Fax

Practice location:
  • Phone: 206-432-3575
  • Fax:
Mailing address:
  • Phone: 206-432-3574
  • Fax: 206-432-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1942770896
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCG60835638
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: