Healthcare Provider Details

I. General information

NPI: 1083237101
Provider Name (Legal Business Name): JOSH D SPELL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 45TH ST STE 600
SEATTLE WA
98105-4696
US

IV. Provider business mailing address

1100 NE 45TH ST STE 600
SEATTLE WA
98105-4696
US

V. Phone/Fax

Practice location:
  • Phone: 206-926-9087
  • Fax:
Mailing address:
  • Phone: 206-926-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: