Healthcare Provider Details

I. General information

NPI: 1740432186
Provider Name (Legal Business Name): ABIGAIL LEE BEATTY BA, CDP, AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E OLIVE ST SOUND MENTAL HEALTH
SEATTLE WA
98122-2735
US

IV. Provider business mailing address

1600 E OLIVE ST SOUND MENTAL HEALTH
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2200
  • Fax: 206-302-2210
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60202441
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00059349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: