Healthcare Provider Details

I. General information

NPI: 1083196539
Provider Name (Legal Business Name): GREGORY MARTIN ATCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 FORT DENT WAY, SUITE 220
SEATTLE WA
98188-8553
US

IV. Provider business mailing address

7100 FORT DENT WAY STE 220S
TUKWILA WA
98188-8553
US

V. Phone/Fax

Practice location:
  • Phone: 502-208-6938
  • Fax:
Mailing address:
  • Phone: 502-208-6938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61588877
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: