Healthcare Provider Details

I. General information

NPI: 1508647413
Provider Name (Legal Business Name): SELF AND OTHER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 FAIRVIEW AVE E STE 204
SEATTLE WA
98102-3051
US

IV. Provider business mailing address

PO BOX 22075
SEATTLE WA
98122-0075
US

V. Phone/Fax

Practice location:
  • Phone: 206-785-3980
  • Fax: 206-480-0987
Mailing address:
  • Phone: 206-785-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HENRY
Title or Position: CO-OWNER
Credential:
Phone: 206-785-3980